ation Population Pop
Population Population Populatk
ation Population Pop
mics Economic
Eco no
Economic
mics Economics Econoi
Status Health Status h
Health Status Health Status He
Status Health Status h
Older
Americans
2005
Key Indicators of Weil-Being
Health Risks and Behavk
ealth Risks and Behaviors Health Ri
Health Risks and Behavk
FEDERAL
INTERAGENCY
FORUM ON
RELATED
STATISTICS
-------
Federal Interagency Forum on Aging-Related Statistics
The Federal Interagency Forum on Aging-Related Statistics (Forum) was founded in 1986 to foster collaboration
among Federal agencies that produce or use statistical data on the older population. Forum agencies as of March
2008 are listed below.
Department of Commerce
U.S. Census Bureau
www. census .gov
Department of Health and Human Services
Administration on Aging
www.aoa.gov
Agency for Healthcare Research and Quality
www.ahrq.gov
Centers for Medicare and Medicaid Services
www.cms.hhs.gov
National Center for Health Statistics
www. cdc.gov/nchs
National Institute on Aging
www.nia.nih.gov
Office of the Assistant Secretary for Planning
and Evaluation
www.aspe .hhs .gov
Substance Abuse and Mental Health
Services Administration
www.samhsa.gov
Department of Housing and
Urban Development
www.hud.gov
Department of Labor
Bureau of Labor Statistics
www.bls.gov
Employee Benefits Security Adminstration
www.dol.gov/ebsa
Department of Veterans Affairs
www.va.gov
Environmental Protection Agency
www.epa.gov
Office of Management and Budget
Office of Statistical and Science Policy
www.whitehouse.gov/omb/inforeg/statpolicy.html
Social Security Administration
Office of Research, Evaluation, and Statistics
www.ssa.gov
Copyright information: All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to
source, however, is appreciated.
Recommended citation: Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: Key Indicators of Well-Being. Federal Interagency
Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office. March 2008.
Report availability: Single copies of this report are available at no charge through the National Center for Health Statistics while supplies last. Requests may
be sent to the Information Dissemination Staff, National Center for Health Statistics, 3311 Toledo Road, Room 5412, Hyattsville, MD 20782. Copies may
also be ordered by calling 1-866-441-NCHS (6247) or by emailing nchsquery@cdc.gov. This report is also available on the World Wide Web at
www. agingstats. gov.
-------
Older
Americans
2008
Key Indicators of Well-Being
MM FEDERAL
W!A INTERAGENCY
• d FORUM ON
RAGING
•• RELATED
•• STATISTICS
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Foreword
Americans age 65 and over are an important
and growing segment of our population. Many
Federal agencies provide data on aspects of
older Americans' lives, but it can be difficult
to fit the pieces together. Thus, it has become
increasingly important for policymakers and
the general public to have an accessible, easy
to understand portrait that shows how older
Americans are faring.
Older Americans 2008: Key Indicators of
Weil-Being (Older Americans 2008) presents a
unified picture of our older population's health
and well-being. It is the fourth chartbook
prepared by the Federal Interagency Forum on
Aging-Related Statistics (Forum), which now
has 15 participating Federal agencies. As with
the earlier volumes, readers will find here an
accessible compendium of indicators drawn
from the most reliable official statistics. The
indicators are again categorized into five broad
groups: population, economics, health status,
health risks and behaviors, and health care.
The Forum is pleased to include in this edition
a one-time special feature based on the health
literacy component of the National Center for
Education Statistics' 2003 National Assessment
of Adult Literacy. This is the first-ever national
assessment designed specifically to measure
adults' ability to use literacy skills to read and
understand health-related information.
This year's report also incorporates two new
regular indicators: housing problems and use
of time. The first, the ability to afford quality
housing, is an issue fundamental to the well-being
of all Americans. The second, how older people
spend their time, resulted from a workshop the
Forum cosponsored with the Gerontological
Society of America. The short-term goal of the
workshop was to help identify a new indicator
on social activity to replace an earlier one based
on a data source that has been discontinued. The
long-term goal was to identify data needs that
could lead to future collaborations. The Forum
believes these two new indicators will enhance
our portrait of older Americans.
While Federal agencies currently collect and
report substantial information on the population
age 65 and over, there remain gaps in our
knowledge. This year, the Forum identified six
areas where data are needed to develop new
indicators: caregiving, elder abuse, functional
limitations and disability, mental health,
pension measures, and residential care. We also
appreciate users' requests for greater detail for
many existing indicators. The Forum continues
to encourage extending age reporting categories,
oversampling older racial and ethnic populations,
collecting data at lower levels of geography,
and including the institutionalized population in
national surveys. By displaying what we know
and do not know, this report challenges Federal
statistical agencies to do even better.
The Older Americans reports reflect the Forum's
commitment to advancing our understanding of
where older Americans stand today and what
they may face tomorrow. I congratulate the
Forum agencies for joining together to enhance
their work and present the American people
with a valuable tool. Last, but not least, none
of this work would be possible without the
continued cooperation of millions of American
citizens who willingly provide the data that are
summarized and analyzed by staff in the Federal
agencies.
We invite you to suggest ways in which we
can enhance this biennial portrait of older
Americans. Please send comments to us at the
Forum's website (www.agingstats.gov). I hope
that our compendium will continue to be useful
in your work.
Katherine K. Wallman
Chief Statistician
Office of Management and Budget
-------
Acknowledgments
Older Americans 2008: Key Indicators of Well-
Being is a report of the Federal Interagency
Forum on Aging-Related Statistics (Forum).
This report was prepared by the Forum's planning
committee and reviewed by the Forum's principal
members, which include Josefina Carbonell,
Administration on Aging (AoA); Steven Cohen,
Agency for Healthcare Research and Quality
(AHRQ); Thomas Nardone, Bureau of Labor
Statistics (BLS); Howard Hogan, U.S. Census
Bureau; Thomas Reilly, Centers for Medicare
and Medicaid Services (CMS); Jean Lin Pao,
Department of Housing and Urban Development
(HUD); Joseph Piacentini, Employee Benefits
Security Administration (EBSA); William
Sanders, Environmental Protection Agency
(EPA); Edward Sondik, National Centerfor Health
Statistics (NCHS); Richard Suzman, National
Institute on Aging (NIA); Steven Tingus, Office
of the Assistant Secretary for Planning and
Evaluation (ASPE), Department of Health and
Human Services; Katherine K. Wallman, Office
of Management and Budget (OMB); Daryl
Kade, Substance Abuse and Mental Health
Services Administration (SAMHSA); Susan
Grad, Social Security Administration (SSA);
and Dat Tran, Department of Veterans Affairs
(VA).
The following members of the Forum agencies
reviewed the chartbook and provided valuable
guidance and assistance: Frank Burns, AoA;
Nancy Gordon, U.S. Census Bureau; Jennifer
Madans, NCHS; Ruth Katz, ASPE; and Ray
Vogel, VA.
The Forum's planning committee members
include Saadia Greenberg, AoA; David Kashi-
hara and D.E.B. Potter, AHRQ; Emy Sok, BLS;
Karen Humes and Kevin Kinsella, U.S. Census
Bureau; Gerald Riley, CMS; Meena Bavan
and Cheryl Levine, HUD; Anja Decressin,
EBSA; Kathy Sykes, EPA; Ellen Kramarow
and Julie Dawson Weeks, NCHS; John Haaga,
NIA; William Marton, ASPE; Rochelle Wilkie
Martinez, OMB; Ingrid Goldstrom and Lisa
Park, SAMHSA; Howard lams, SSA; Linda
Bergofsky and Christine Elnitsky, VA; and the
Forum's Staff Director, Kristen Robinson.
In addition to the 15 agencies of the Forum,
the Department of Agriculture (USD A) and the
Department of Education (ED) were invited to
contribute to this report. The Forum greatly
appreciates the efforts of Patricia Guenther and
WenYen Juan, Center for Nutrition Policy and
Promotion, USDA; and Sheida White, National
Center for Education Statistics, ED, in providing
valuable information from their agencies.
Other staff members of Federal agencies who
provided data and assistance include Jennifer
Klocinski, AoA; Rachel Krantz-Kent and
Geoffrey Paulin, BLS; Marcella Jones, U.S.
Census Bureau; Rick Andrews, Franklin Eppig,
Deborah Kidd, Chris McCormick, Maggie
Murgolo, and Joseph Regan, CMS; Janet F.
Cakir, EPA; Carolyn Lynch, HUD; Robert
Anderson, Amy Bernstein, Liming Cai, Robin
Cohen, Ginny Freid, Lauren Harris-Kojetin,
Melonie Heron, James Lubitz, and Rhonda
Robinson, NCHS; Elizabeth Hamilton and
Vicky Cahan, NIA; Anne DeCesaro and Lynn
Fisher, SSA; and Peter Ahn, Jin Kim, and Cathy
Tomczak, VA.
The Forum is also indebted to the people outside
the Federal government who contributed to
this chartbook: Mohammed Kabeto, Kate
McGonagle, Robert Schoeni, Frank Stafford,
and David Weir, University of Michigan.
Member agencies of the Forum provided funds
and valuable staff time to produce this report.
NCHS and its contractor, NOVA Research Com-
pany, facilitated the production, printing, and
dissemination of this report. Odell D. Eldridge,
NOVA, designed the layout and supervised the
overall presentation of the report, Kyung Park,
NOVA, designed and produced the data tables,
Megan M. Cox and Demarius V Miller, CDC/
CCHIS/NCHM/Division of Creative Services,
Writer-Editor Services Branch, provided editor-
ial oversight and review. Patricia L. Wilson,
CDC/OCOO/MASO, managed the printing of
the report.
-------
About This Report
Introduction
Older Americans 2008: Key Indicators of Weil-
Being (Older Americans 2008) is the fourth
in a series of reports produced by the Federal
Interagency Forum on Aging-Related Statistics
(Forum) that describe the overall status of the
U.S. population age 65 and over. Once again,
this report uses data from over a dozen national
data sources to construct broad indicators of
well-being for the older population and to
monitor changes in these indicators over time.
By following these data trends, more accessible
information will be available to target efforts to
improve the lives of older Americans.
While most of Older Americans 2008 remains
the same as earlier editions, two new indicators
have been added and several existing indicators
have been revised to provide a more complete
picture of the health and well-being of older
Americans. The two new indicators in this
report are housing problems and use of time.
The revised indicators include total expenditures
(formerly housing expenditures), depressive
symptoms, functional limitations (formerly
disability), prescription drugs, nursing home
utilization, andpersonal assistance and equipment
(formerly caregiving and assistive device use).
An indicator on memory impairment, which is
no longer available, is listed as a data need under
"Mental Health." In addition to these new and
revised indicators, this report has been expanded
to include a one-time special feature on two
important issues facing many older Americans
today—literacy and health literacy.
The Forum hopes that this report will stimulate
discussions by policymakers and the public,
encourage exchanges between the data and
policy communities, and foster improvements
in Federal data collection on older Americans.
By examining a broad range of indicators,
researchers, policymakers, service providers, and
the Federal government can better understand
the areas of well-being that are improving for
older Americans and the areas of well-being that
require more attention and effort.
Structure of the Report
Older Americans 2008 is designed to present
data in a nontechnical, user-friendly format;
it complements other more technical and
comprehensive reports produced by the
individual Forum agencies. The report includes
38 indicators that are grouped into five sections:
Population, Economics, Health Status, Health
Risks and Behaviors, and Health Care. A list of
the indicators included in this report is located
in the Table of Contents on page IX.
Each indicator includes the following:
4 An introductory paragraph that describes
the relevance of the indicator to the well-
being of the older population.
4 One or more charts that graphically display
analyses of the data.
4 Bulleted highlights of salient findings from
the data and other sources. The data used to
develop the indicators and their accom-
panying bullets are presented in table
format in Appendix A. Data source descrip-
tions are provided in Appendix B. A
glossary is supplied in Appendix C.
Selection Criteria for Indicators
Older Americans 2008 presents 38 key indicators
that measure critical aspects of older people's
lives. The Forum chose these indicators because
they meet the following criteria:
4 Easy to understand by a wide range of
audiences.
4 Based on reliable, nationwide data (spon-
sored, collected, or disseminated by the
Federal government).
4 Objectively based on substantial research
that connects them to the well-being of
older Americans.
4 Balanced so that no single area dominates
the report.
4 Measured periodically (not necessarily
annually) so that they can be updated as
appropriate and show trends overtime.
4 Representative of large segments of the
aging population, rather than one particular
group.
-------
Considerations When Examining
the Indicators
Older Americans 2008 generally addresses
the U.S. population age 65 and over. Mutually
exclusive age groups (e.g., age 65-74, 75-
84, and 85 and over) are reported whenever
possible.
Data availability and analytical relevance may
affect the specific age groups that are included
for an indicator. For example, because of small
sample sizes in some surveys, statistically
reliable data for the population age 85 and over
often are not available. Conversely, data from the
population younger than age 65 sometimes are
included if they are relevant to the interpretation
of the indicator. For example, in "Indicator 11:
Participation in the Labor Force," a comparison
with a younger population enhances the
interpretation of the labor force trends among
people age 65 and over.
To standardize the age distribution of the 65 and
over population across years, some estimates
have been age adjusted by multiplying age
specific rates by age specific weights. If an
indicator has been age adjusted, it will be stated
in the note under the chart(s) as well as under
the corresponding table(s) in Appendix A.
Because the older population is becoming more
diverse, analyses often are presented by sex,
race and Hispanic origin, income, and other
characteristics.
Updated indicators in Older Americans 2008 are
not always comparable to indicators in Older
Americans 2000, 2004, or Update 2006. The
replication of certain indicators with updated
data is sometimes difficult because of changes
in data sources, definitions, questionnaires, and/
or reporting categories. A comparability table
is available on the Forum's website at www.
agingstats.gov to help readers understand the
changes that have taken place.
The reference population (the base population
sampled at the time of data collection) for each
indicator is clearly labeled under each chart and
table and defined in the glossary. Whenever
possible, the indicators include data on the U.S.
resident population (i.e., people living in the
community and people living in institutions).
However, some indicators show data only for
the civilian noninstitutionalized population.
Because the older population residing in nursing
homes (and other long-term care institutional
settings) is excluded from samples based on the
noninstitutionalized population, caution should
be exercised when attempting to generalize the
findings from these data sources to the entire
population age 65 and over. This is especially
true for the older age groups. For example
in 2007, only 86 percent of the population
age 85 and over was included in the civilian
noninstitutionalized population as defined by the
U.S. Census Bureau.
Civilian noninstitutionalized population as a percentage of the total resident
population by age: September 1, 2007
Survey Years
In the charts, tick marks along the x-axis indicate
years for which data are available. The range
of years presented in each chart varies because
data availability is not uniform across the data
sources. To standardize the time frames across
the indicators, a timeline has been placed at the
bottom of each indicator that reports data for
more than one year.
1930 1940 1950 1960 1970
Accuracy of the Estimates
Most data in this report are based on a sample
of the population and are, therefore, subject
to sampling error. Standard tests of statistical
significance have been used to determine
whether the differences between populations
exist at generally accepted levels of confidence
or whether they occurred by chance. Unless
otherwise noted, only differences that are
statistically significant at the 0.05 level are
discussed in the text. To indicate the reliability
of the estimates, standard errors for selected
estimates in the chartbook can be found on the
Forum's website at www.agingstats.gov.
Finally, the data in some indicators may not sum
to totals because of rounding.
-------
Sources of Data
The data used to create the charts are provided
in tables in the back of the report (Appendix A).
The tables also contain data that are described in
the bullets below each chart. The source of the
data for each indicator is noted below the chart.
Descriptions of the data sources can be found in
Appendix B. Additional information about these
data sources is available on the Forum's website
at www.agingstats.gov.
Occasionally, data from another publication are
included to give a more complete explanation
of the indicator. The citations for these sources
are included in the "References" section (page
69). For those who wish to access the survey
data used in this chartbook, contact information
is given for each of the data sources in
Appendix B.
Data Needs
Because Older Americans 2008 is a collabor-
ative effort of many Federal agencies, a
comprehensive array of data was available
for inclusion in this report. However, even
with all of the data available, there are still
areas where scant data exist. Although the
indicators that were chosen cover a broad
range of components that affect well-being,
there are other issues that the Forum would
like to address in the future. These issues are
identified in the "Data Needs" section (page 67).
Mission
The Forum's mission is to encourage cooperation
and collaboration among Federal agencies to
improve the quality and utility of data on the
aging population. To accomplish this mission,
the Forum provides agencies with a venue to
discuss data issues and concerns that cut across
agency boundaries, facilitates the develop-
ment of new databases, improves mechanisms
currently used to disseminate information on
aging-related data, invites researchers to report
on cutting-edge analyses of data, and encourages
international collaboration.
The specific goals of the Forum are to improve
both the quality and use of data on the aging
population by:
4 Widening access to information on the
aging population through periodic pub-
lications and other means.
4 Promoting communication among data
producers, researchers, and public policy-
makers.
4 Coordinating the development and use of
statistical databases among Federal
agencies.
4 Identifying information gaps and data
inconsistencies.
4 Investigating questions of data quality.
4 Encouraging cross-national research and
data collection on the aging population.
4 Addressing concerns regarding collection,
access, and dissemination of data.
Financial Support
The Forum members provide funds and valuable
staff time to support the activities of the Forum.
More Information
If you would like more information about Older
Americans 2008 or other Forum activities,
contact:
Kristen Robinson, Ph.D.
Staff Director
Federal Interagency Forum on Aging-Related
Statistics
3311 Toledo Road, Room 6321
Hyattsville, MD 20782
Phone:(301)458-4460
Fax:(301)458-4038
E-mail: agingforum@cdc.gov
Website: www.agingstats.gov
-------
Older Americans on the Internet
Supporting material for this report can be found
at www.agingstats.gov. The website contains the
following:
4 Data for all of the indicators in Excel
spreadsheets (with standard errors, when
available).
4 Data source descriptions.
4 PowerPoint slides of the charts.
+ A comparability table explaining the
changes to the indicators that have taken
place between Older Americans 2000, 2004,
Update 2006, and 2008.
The
4
*
^
Forum's website also provides:
Ongoing Federal data resources relevant
to the study of the aging.
Links to aging-related statistical inform-
ation on Forum member websites.
Other Forum publications (including Data
Sources on Older Americans 2006).
Workshop presentations, papers, and
reports.
Agency contacts.
Subject area contact list for Federal
statistics.
Information about the Forum.
Additional Online Resources
Administration on Aging
Statistics on the Aging Population
www.aoa.gov/prof/Statistics/statistics.asp
A Profile of Older Americans
www.aoa.gov/prof/Statistics/profile/profiles.asp
Online Statistical Data on the Aging
www.aoa.gov/prof/Statistics/online_stat_data/
online_stat_data. asp
Agency for Healthcare Research and Quality
AHRQ Data and Surveys
www. ahrq . gov/data
Bureau of Labor Statistics
Bureau of Labor Statistics Data
www. stats .bis .gov/data
U.S. Census Bureau
Statistical Abstract of the United States
www. census .gov/compendia/statab
Age Data
www.census.gov/population/www/socdemo/
age .html
Longitudinal Employer-Household Dynamics
Lehd. did. census .gov/led
Centers for Medicare and Medicaid Services
CMS Data and Statistics
www. cms .hhs .gov/home/rsds. asp
Department of Housing and Urban
Development
Policy Development and Research Information
Services
www.huduser.org/
Department of Veterans Affairs
Veteran Data and Information
www 1 .va.gov/vetdata
Employee Benefits Security Administration
Publications and Reports
www.dol.gov/ebsa/publications/main.
html#section8
Environmental Protection Agency
Aging Initiative
www.epa.gov/aging
Information Resources
www.epa.gov/aging/resources/index.htm
National Center for Health Statistics
Aging Activities
www.cdc.gov/nchs/agingact.htm
Longitudinal Studies of Aging
www.cdc.gov/nchs/lsoa.htm
Health, United States
www. cdc.gov/nchs/hus .htm
National Institute on Aging
NIA Centers on the Demography of Aging
www. agingcenters. org/
National Archive of Computerized Data on
Aging
www.icpsr.umich.edu/NACDA
Publicly Available Datasets for Aging-Related
Secondary Analysis
www.nia.nih.gov/researchinformation/
scientificresources
-------
Office of the Assistant Secretary for Planning
and Evaluation, HHS
Office of Disability, Aging, and Long-Term Care
Policy
www.aspe .hhs .gov/_/office_specific/daltcp .cfm
Office of Management and Budget
Federal Committee on Statistical Methodology
www. fcsm .gov
Social Security Administration
Social Security Administration Statistical
Information
www.ssa.gov/policy
Substance Abuse and Mental Health Services
Administration
Office of Applied Studies
www. oas. samhsa.gov
Center for Mental Health Services
www.mentalhealth.samhsa.gov/cmhs/
MentalHealthStatistics
Other Resources
FedStats.Gov
www.fedstats.gov
Council of Professional Associations on
Federal Statistics
www.copafs.org
-------
Table of Contents
Foreword II
Acknowledgments III
About This Report IV
List of Tables X
Highlights XIV
Population 1
Indicator 1: Number of Older
Americans 2
Indicator 2: Racial and Ethnic
Composition 4
Indicator 3: Marital Status 5
Indicator 4: Educational Attainment .... 6
Indicator 5: Living Arrangements 8
Indicator 6: Older Veterans 9
Economics
Indicator 7: Poverty
Indicator 8: Income
Indicator 9: Sources of Income
Indicator 10: Net Worth
Indicator 11: Participation in the
Labor Force
Indicator 12: Total Expenditures . . .
Indicator 13: Housing Problems
Health Status
Indicator 14: Life Expectancy
Indicator 15: Mortality
Indicator 16: Chronic Health
Conditions
Indicator 17: Sensory Impairments
and Oral Health
Indicator 18: Respondent-Assessed
Health Status
Indicator 19: Depressive Symptoms .
Indicator 20: Functional Limitations .
Health Risks
Indicator 21:
Indicator 22:
Indicator 23:
Indicator 24:
Indicator 25:
Indicator 26:
Indicator 27:
Indicator 28:
and Behaviors
Vaccinations
Mammography . . .
Diet Quality
Physical Activity . .
Obesity
Cigarette Smoking
Air Quality
Use of Time
11
12
13
14
16
18
20
21
23
24
26
27
28
29
30
32
35
36
37
38
39
40
41
42
44
Health Care
Indicator 29: Use of Health Care
Services
Indicator 30: Health Care
Expenditures
Indicator 31: Prescription Drugs .
Indicator 32: Sources of Health
Insurance
Indicator 33: Out-of-Pocket Health
Care Expenditures
Indicator 34: Sources of Payment
for Health Care Services
Indicator 35: Veterans' Health Care
Indicator 36: Nursing Home
Utilization
Indicator 37: Residential Services .
Indicator 38: Personal Assistance
and Equipment
Special Feature
Literacy
Health Literacy
Data Needs
References
Appendix A: Detailed Tables
Appendix B: Data Source
Descriptions
Appendix C: Glossary
. 47
. 48
. 50
. 52
. 54
. 55
. 56
. 57
. 58
. 60
. 62
. 64
. 64
. 65
. 67
. 69
. 73
135
149
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List of Tables
Population
Indicator 1: Number of Older
Americans
Table la. Number of people age 65
and over and 85 and over, selected
years 1900-2006 and projected
2010-2050
Table Ib. Percentage of the population
age 65 and over and 85 and over, sel-
ected years 1900-2006 and projected
2010-2050
Table Ic. Population of countries or
areas with at least 10 percent of their
population age 65 and over, 2006 . . .
Table Id. Percentage of the population
age 65 and over, by State, July 1,
2006
Table le. Percentage of the population
age 65 and over, by county, 2006 . . .
Table If Number and percentage of
people age 65 and over and 85 and
over, by sex, 2006
74
74
75
76
77
77
Indicator 2: Racial and Ethnic
Composition
Table 2. Population age 65 and over,
by race and Hispanic origin, 2006
and projected 2050
Indicator 3: Marital Status
Table 3. Marital status of the
population age 65 and over, by age
group and sex, 2007
Indicator 4: Educational Attainment
Table 4a. Educational attainment
of the population age 65 and over,
selected years 1965-2007
Table 4b. Educational attainment of
the population age 65 and over, by
sex and race and Hispanic origin,
2007
Indicators: Living Arrangements
Table 5 a. Living arrangements of the
population age 65 and over, by sex
and race and Hispanic origin, 2007. .
Table 5b. Population age 65 and over
living alone, by age group and sex,
selected years 1970-2007
77
78
78
78
79
79
Indicator 6: Older Veterans
Table 6a. Percentage of people age 65
and over who are veterans, by sex
and age group, United States and
Puerto Rico, 1990, 2000, and pro-
jected 2010
Table 6b. Estimated and projected
number of veterans age 65 and
over, by sex and age group, United
States and Puerto Rico, 1990, 2000,
and projected 2010
Economics
Indicator 7: Poverty
Table 7a. Percentage of the population
living in poverty, by age group,
1959-2006
80
Table 7b. Percentage of the population
age 65 and over living in poverty, by
selected characteristics, 2006
Indicator 8: Income
Table 8a. Income distribution of the
population age 65 and over, 1974-
2006
Table 8b. Median income of house-
holders age 65 and over, in current
and 2006 dollars, 1974-2006
Indicator 9: Sources of Income
Table 9a. Distribution of sources of
income for married couples and
nonmarried people who are age 65
and over, selected years 1962-2006 .
Table 9b. Sources of income for
married couples and nonmarried
people who are age 65 and over, by
income quintile, 2006
Table 9c. Percentage of people age
55 and over with family income
from specified sources, by age group,
2006
Indicator 10: Net Worth
Table 10. Median household net worth
of head of household, by selected
characteristics, in 2005 dollars,
selected years 1984-2005
81
82
83
84
85
85
86
87
Indicator 11: Participation in the
Labor Force
Table 11. Labor force participation
rates of people age 55 and over, by
age group and sex, annual averages,
1963-2006
Indicator 12: Total Expenditures
Table 12. Percentage of total house-
hold annual expenditures by age of
reference person, 2005
Indicator 13: Housing Problems
Table 13a. Percentage of households
with residents age 65 and over that
report housing problems, by type of
problem, selected years 1985-2005
89
89
80
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Table 13b. Percentage of all U.S.
households that report housing
problems, by type of problem,
selected years 1985-2005
Health Status
Indicator 14: Life Expectancy
Table 14a. Life expectancy, by age and
sex, selected years 1900-2004
Table 14b. Life expectancy, by age and
race, 2004
Table 14c. Average life expectancy at
age 65, by sex and selected countries
or areas, selected years 1980-2003 . .
Indicator 15: Mortality
Table 15a. Death rates for selected
leading causes of death among
people age 65 and over, 1981-2004. .
Table 15b. Leading causes of death
among people age 65 and over, by
sex and race and Hispanic origin,
2004
Table 15c. Leading causes of death
among people age 85 and over, by
sex and race and Hispanic origin,
2004
Indicator 16: Chronic Health
Conditions
Table 16a. Percentage of people age
65 and over who reported having
selected chronic health conditions,
by sex, 2005-2006
Table 16b. Percentage of people age
65 and over who reported having
selected chronic health conditions,
1997-2006
91
93
93
94
95
96
98
100
100
Indicator 17: Sensory Impairments
and Oral Health
Table 17a. Percentage of people age
65 and over who reported having any
trouble hearing, any trouble seeing,
or no natural teeth, by selected
characteristics, 2006
Table 17b. Percentage of people age 65
and over who reported ever having
worn a hearing aid, 2006
101
101
Indicator 18: Respondent-Assessed
Health Status
Table 18. Respondent-assessed health
status among people age 65 and over,
by selected characteristics, 2004-
2006
Indicator 19: Depressive Symptoms
Table 19a. Percentage of people age
65 and over with clinically relevant
depressive symptoms, by sex,
selected years 1998-2004
Table 19b. Percentage of people age
65 and over with clinically relevant
depressive symptoms, by age group
and sex, 2004
103
103
Indicator 20: Functional Limitations
Table 20a. Percentage of Medicare
enrollees age 65 and over who have
limitations in activities of daily
living (ADLs) or instrumental act-
ivities of daily living (lADLs), or
who are in a facility, selected years
1992-2005
Table 20b. Percentage of Medicare
enrollees age 65 and over who are
unable to perform certain physical
functions, by sex, 1991 and 2005 . .
Table 20c. Percentage of Medicare
enrollees age 65 and over who
are unable to perform any one of
five physical functions, by selected
characteristics, 2005
104
105
105
Health Risks and Behaviors
Indicator 21: Vaccinations
Table 2 la. Percentage of people age
65 and over who reported having
been vaccinated against influenza
and pneumococcal disease, by race
and Hispanic origin, selected years
1989-2006
Table 2 Ib. Percentage of people age
65 and over who reported having
been vaccinated against influenza
and pneumococcal disease, by
selected characteristics, 2006
Indicator 22: Mammography
Table 22. Percentage of women who
reported having had a mammogram
within the past 2 years, by selected
characteristics, selected years 1987-
2005
Indicator 23: Diet Quality
Table 23. Healthy Eating Index-2005
(HEI-2005) total and component scores
for people age 55 and over, by age
group, 2001-2002
106
106
107
108
102
-------
Indicator 24: Physical Activity
Table 24a. Percentage of people age
45 and over who reported engaging in
regular leisure time physical activity,
by age group, 1997-2006 109
Table 24b. Percentage of people age 65
and over who reported engaging in
regular leisure time physical activity,
by selected characteristics, 2005-2006 . . 109
Indicator 25: Obesity
Table 25. Body weight status among
people age 65 and over, by sex and
age group, selected years 1976-2006 ... 110
Indicator 26: Cigarette Smoking
Table 26a. Percentage of people age
45 and over who are current cigarette
smokers, by selected characteristics,
selected years 1965-2007 Ill
Table 26b. Cigarette smoking status of
people age 18 and over, by sex and age
group, 2006 112
Indicator 27: Air Quality
Table 27a. Percentage of people age 65
and over living in counties with "poor
air quality," 2000-2006 112
Table 27b. Counties with "poor air
quality" for any standard in 2006 113
Indicator 28: Use of Time
Table 28a. Percentage of day that people
age 55 and over spent doing selected
activities on an average day, by age
group, 2006 115
Table 28b. Percentage of total leisure
time that people age 55 and over spent
doing selected leisure activities on an
average day, by age group, 2006 115
Health Care
Indicator 29: Use of Health Care
Services
Table 29a. Use of Medicare-covered
health care services by Medicare
enrollees age 65 and over, 1992-2005 ... 116
Table 29b. Use of Medicare-covered
home health and skilled nursing
facility services by Medicare enrollees
age 65 and over, by age group, 2005 .... 116
Indicator 30: Health Care
Expenditures
Table 30a. Average annual health care
costs for Medicare enrollees age 65
and over, in 2004 dollars, by age
group, 1992-2004
Table 3 Ob. Major components of health
care costs among Medicare enrollees
age 65 and over, 1992 and 2004 ....
Table 30c. Average annual health care
costs among Medicare enrollees age
65 and over, by selected character-
istics, 2004
Table 30d. Major components of health
care costs among Medicare enrollees
age 65 and over, by age group, 2004 .
Table 30e. Percentage of Medicare
enrollees age 65 and over who
reported problems with access to
health care, 1992-2003
117
117
118
118
119
Indicator 31: Prescription Drugs
Table 3 la. Average annual prescription
drug costs and sources of payment
among noninstitutionalized Medicare
enrollees age 65 and over, 1992-2004.
Table 31b. Distribution of annual
prescription drug costs among
noninstitutionalized Medicare
enrollees age 65 and over, 2004
Table 3 Ic. Number of Medicare
enrollees age 65 and over who
enrolled in Part D prescription drug
plans or who were claimed for Retiree
Drug Subsidy payments, June 2006
and September 2007
Table 3 Id. Average prescription drug
costs among noninstitutionalized
Medicare enrollees age 65 and over,
by selected characteristics, 2000,
2002, and 2004
119
119
120
120
Indicator 32: Sources of Health
Insurance
Table 32a. Percentage of noninstitu-
tionalized Medicare enrollees age 65
and over with supplemental health
insurance, by type of insurance,
1991-2005
Table 32b. Percentage of people age
55-64 with health insurance
coverage, by type of insurance and
poverty status, 2006
121
122
-------
Indicator 33: Out-of-Pocket Health
Care Expenditures
Table 33a. Percentage of people age 55
and over with out-of-pocket expendi-
tures for health care service use, by
age group, selected years 1977-2004
Table 33b. Out-of-pocket health
care expenditures as a percentage
of household income, among people
age 65 and over with out-of-pocket
expenditures, by selected character-
istics, selected years 1977-2004
Table 33c. Distribution of total out-
of-pocket health care expenditures
among people age 65 and over, by
type of health care services and age
group, selected years 2000-2004....
Indicator 34: Sources of Payment for
Health Care Services
Table 34a. Sources of payment for
health care services for Medicare
enrollees age 65 and over, by type of
service, 2004
Table 34b. Sources of payment for
health care services for Medicare
enrollees age 65 and over, by income,
2004
Indicator 35: Veterans' Health Care
Table 35. Total number of veterans
age 65 and over who are enrolled
in or receiving health care from the
Veterans Health Administration,
1990-2006
122
123
124
125
125
126
Indicator 36: Nursing Home
Utilization
Table 36a. Rate of nursing home
residence among people age 65 and
over, by sex and age group, selected
years 1985-2004
Table 36b. Number of current nursing
home residents age 65 and over, by
sex and age group, selected years
1985-2004
Table 36c. Percentage of nursing home
residents age 65 and over, by amount
of assistance with activities of daily
living (ADLs), 2004
127
128
129
Indicator 37: Residential Services
Table 37a. Percentage of Medicare
enrollees age 65 and over residing
in selected residential settings, by age
group, 2005
Table 37b. Percentage of Medicare
enrollees age 65 and over with
functional limitations, by residential
setting, 2005
Table 37c. Availability of specific
services among Medicare enrollees
age 65 and over residing in
community housing with services,
2005
Table 37d. Annual income distribution
of Medicare enrollees age 65 and
over, by residential setting, 2005
Table 37e. Characteristics of services
available to Medicare enrollees age
65 and over residing in community
housing with services, 2005
130
130
. 131
. 131
. 132
Indicator 38: Personal Assistance and
Equipment
Table 38a. Distribution of noninstitu-
tionalized Medicare enrollees age 65
and over who have limitations in act-
ivities of daily living (ADLs), by type
of assistance, selected years 1992-
2005 132
Table 38b. Percentage of noninstitution-
alized Medicare enrollees age 65 and
over who have limitations in instru-
mental activities of daily living
(lADLs) and who receive personal
assistance, by age group, selected
years 1992-2005 132
Special Feature: Literacy and
Health Literacy
Literacy Table. Percentage of people
age 65 and over in each literacy
performance level, by literacy
component, 1992 and 2003
Health Literacy Table. Percentage of
people age 50 and over in each health
literacy performance level, by age
group, 2003
133
133
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Highlights
Older Americans 2008: Key Indicators of Well-
Being is one in a series of periodic reports to
the Nation on the condition of older adults in
the United States. The indicators assembled in
this chartbook show the results of decades of
progress. Older Americans are living longer and
enjoying greater prosperity than any previous
generation. Despite these advances, inequalities
between the sexes, and among income groups,
and racial and ethnic groups continue to exist.
As the Baby Boomers continue to age and
America's older population grows larger and
more diverse, community leaders, policymakers,
and researchers will have an even greater need
to monitor the health and economic well-being
of older Americans. In this report, 38 indicators
(and one special feature) depict the well-being
of older Americans in the areas of demographic
characteristics, economic circumstances, overall
health status, trends in health risks and beha-
viors, and cost and use of health care services.
Selected highlights from each section of the
report follow.
Population
The demographics of aging continue to change
dramatically. The older population is growing
rapidly, and the aging of the "baby boomers,"
born between 1946 and 1964 (and who begin
turning age 65 in 2011), will accelerate this
growth. This largerpopulation of older Americans
will be more racially diverse and belter educated
than previous generations. Another significant
trend is the increase in the proportion of men age
85 and over who are veterans.
4 In 2006, there were an estimated 37 million
people age 65 and over in the United States,
accounting for just over 12 percent of the
total population. The older population in
2030 is expected to be twice as large as
in 2000, growing from 35 million to 71.5
million and representing nearly 20 percent
of the total U.S. population. (See "Indicator
1: Number of Older Americans.")
4 In 1965, 24 percent of the older population
had graduated from high school, and only
5 percent had at least a bachelor's degree. By
2007, 76 percent were high school graduates,
and 19 percent had a bachelor's degree
or more. (See "Indicator 4: Educational
Attainment.")
4 The number of men age 85 and over who are
veterans has more than doubled between
1990 and 2000 from 150,000 to 400,000 and
is projected to reach almost 1.2 million by
2010. The proportion of men age 85 and
over who are veterans is projected to increase
from 33 percent in 2000 to 60 percent in
2010. (See "Indicator 6: Older Veterans.")
Economics
Overall, most older people are enjoying more
prosperity than any previous generation. There
has been an increase in the proportion of
older people in the high-income group and
a decrease in the proportion of older people
living in poverty, as well as a decrease in the
proportion in the low-income group. Among
older Americans, the share of aggregate income
coming from earnings has increased since the
mid-1980s, partly because more older people,
especially women, continue to work past age
55. Finally, on average, net worth has increased
almost 80 percent for older Americans over the
past 20 years. Yet major inequalities continue to
exist with older blacks and people without high
school diplomas reporting smaller economic
gains and fewer financial resources overall.
4 Between 1974 and 2006, there was a decrease
in the proportion of older people with income
below poverty from 15 percent to 9 percent
and with low income from 35 percent to 26
percent; and an increase in the proportion
of people with high income from 18 percent to
29 percent. (See "Indicator 8: Income.")
4 In 2005, the median net worth of households
headed by white people age 65 and over
($226,900) was 6 times that of older black
households ($37,800). This difference is less
than it was in 2003 when the median net worth
of households headed by older white people
was 8 times higher than that of households
headed by older black people. (See "Indicator
10: Net Worth.")
4 Labor force participation rates have risen
among all women age 55 and over during the
past four decades with a majority of the
increase occurring after 1985. Labor force
participation rates among men age 55 and over
-------
have gradually begun to increase after a steady
decline from the early 1960s to the mid-
1990s. (See "Indicator 11: Participation in the
Labor Force.")
Health Status
Americans are living longer than ever before,
yet their life expectancies lag behind those of
other developed nations. Older age is often
accompanied by increased risk of certain
diseases and disorders. Large proportions of
older Americans report a variety of chronic
health conditions such as hypertension and
arthritis. Despite these and other conditions, the
rate of functional limitations among older people
has declined in recent years.
4 Life expectancy at age 65 in the United States
is lower than that of many other industrialized
nations. In 2003 women age 65 in Japan
could expect to live on average 3.2 years
longer than women in the United States.
Among men, the difference was 1.2 years.
(See "Indicator 14: Life Expectancy.")
+ The prevalence of certain chronic conditions
differs by sex. Women report higher levels
of arthritis (54 percent versus 43 percent) than
men. Men report higher levels of heart disease
(37 percent versus 26 percent) and cancer (24
percent versus 19 percent). (See "Indicator 16:
Chronic Health Conditions.")
^ Between 1992 and 2005, the age adjusted
proportion of people age 65 and over with a
functional limitation declined from 49 percent
to 42 percent. (See "Indicator 20: Functional
Limitations.")
Health Risks and Behaviors
Social and lifestyle factors can affect the health
and well-being of older Americans. These factors
include preventive behaviors such as cancer
screenings and vaccinations along with diet,
physical activity, obesity, and cigarette smoking.
Health and well-being is also affected by the
quality of the air where people live and by the
time they spend socializing and communicating
with others. Many of these health risks and
behaviors have shown long-term improvements,
even though recent estimates indicate no
significant changes.
4 The proportion of leisure time that older
Americans spent socializing and commun-
icating—such as visiting friends or attend-
ing or hosting social events—declined
with age. For Americans age 55-64, 13
percent of leisure time was spent socializing
and communicating compared with 10 percent
for those age 75 and over. (See "Indicator 28:
Use of Time.")
+ There was no significant change in the
percentage of people age 65 and over reporting
physical activity between 1997 and 2006.
(See "Indicator 24: Physical Activity.")
4 As with other age groups, the percentage
of people age 65 and over who are obese has
increased between 1988-1994 and 2005-
2006, from 22 percentto 31 percent. However,
over the past several years, the trend has
leveled off, with no statistically significant
change in obesity for older men or women
between 1999-2000 and 2005-2006. (See
"Indicator 25: Obesity.")
4 The percentage of people age 65 and over
living in counties that experienced poor air
quality for any air pollutant decreased from
55 percent in 2000 to 34 percent in 2006. (See
"Indicator 27: Air Quality.")
Health Care
Overall, health care costs have risen dramatically
for older Americans. In addition, between 1992
and 2004, the percentage of health care costs
going to prescription drugs almost doubled
from 8 percent to 15 percent, with prescription
drugs accounting for a large percentage of out-
of-pocket health care spending. To help ease the
burden of prescription drug costs, Medicare Part
D prescription drug coverage began in January
2006.
^ After adjustment for inflation, health care
costs increased significantly among older
Americans from $8,644 in 1992 to $13,052
in 2004. (See "Indicator 30: Health Care
Expenditures.")
4 In 2004, as in the 4 previous years, over
one-half of out-of-pocket health care spending
(excluding health insurance premiums) by
community dwelling people age 65 and over
was used to purchase prescription drugs (from
54 percent in 2000 to 61 percent in 2004).
(See "Indicator 33: Out-of-PocketHealth Care
Expenditures.")
-------
The number of Medicare beneficiaries age
65 and over enrolled in Part D prescription
drug plans increased from 18.2 million
in June 2006 to 19.7 million in September
2007. In September 2007, two-thirds of
enrollees were in stand-alone plans and one-
third were in Medicare Advantage plans. In
addition, approximately 6.5 million bene-
ficiaries were covered by the Retiree Drug
Subsidy in both years (See "Indicator 31:
Prescription Drugs.")
Special Feature: Literacy and
Health Literacy
Many older Americans have difficulty navigating
the health care system because of their low rates
of health lite racy.
4 Older Americans are proportionately more
likely to have below basic health literacy
than any other age group. Almost two-fifths
(39 percent) of people age 75 and over have a
health literacy level of below basic compared
with 23 percent of people age 65-74, and 13
percent of people age 50-64. (See "Special
Feature: Literacy and Health Literacy.")
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Population
Indicator 1: Number of Older Americans
Indicator 2: Racial and Ethnic Composition
Indicator 3: Marital Status
Indicator 4: Educational Attainment
Indicators: Living Arrangements
Indicator 6: Older Veterans
-------
INDICATOR 1
The growth of the population age 65 and over affects many aspects of our society, challenging
policymakers, families, businesses, and health care providers, among others, to meet the needs of aging
individuals.
Number of people age 65 and over, by age group, selected years 1900-2006
and projected 2010-2050
Millions
100
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 |2010 2020 2030 2040 2050
2006 I I
Projected
Note: Data for 2010-2050 are projections of the population.
Reference population: These data refer to the resident population.
Source: U.S.Census Bureau, Decennial Census, Population Estimates and Projections.
In 2006, 37 million people age 65 and over
lived in the United States, accounting for just
over 12 percent of the total population. Over
the 20th century, the older population grew
from 3 million to 37 million. The oldest-old
population (those age 85 and over) grew from
just over 100,000 in 1900 to 5.3 million in
2006.
The Baby Boomers (those born between
1946 and 1964) will start turning 65 in 2011,
and the number of older people will increase
dramatically during the 2010-2030 period.
The older population in 2030 is projected to
be twice as large as in 2000, growing from 35
million to 71.5 million and representing nearly
20 percent of the total U.S. population.
The growth rate of the older population is
projected to slow after 2030, when the last
Baby Boomers enter the ranks of the older
population. From 2030 onward, the proportion
age 65 and over will be relatively stable, at
around 20 percent, even though the absolute
number of people age 65 and over is projected
to continue to grow. The oldest-old population
is projected to grow rapidly after 2030, when
the Baby Boomers move into this age group.
The U.S. Census Bureau projects that the
population age 85 and over could grow from
5.3 million in 2006 to nearly 21 million by
2050. Some researchers predict that death
rates at older ages will decline more rapidly
than is reflected in the U.S. Census Bureau's
projections, which could lead to faster growth
of this population.1"3
1900 1910 1920 1930 1940 1950 1960 1970
1980 1990 2000 2010
2050
-------
INDICATOR 1
Number of Older Americans continued
Percentage of the population age 65
and over, by county and State, 2006
Percentage by State
• 15.0 to 16.8
D 12.4 to 14.9
• 10.0 to 123
CH 6.8 to 9.9
Percentage by county
• 20.0 to 34.5
D 16.0 to 19.9
D 12.4 to 15.9
D 10.0 to 12.3
D 2.6 to 9.9
U.S. total is 12.5
percent.
Reference population: These data refer to the resident population.
Source: U.S. Census Bureau, July 1,2006 Population Estimates.
The proportion of the population age 65 and
over varies by State. This proportion is partly
affected by State fertility and mortality levels
and partly by the number of older and younger
people who migrate to and from the State.
In 2006, Florida had the highest proportion
of people age 65 and over, 17 percent.
Pennsylvania and West Virginia also had high
proportions, over 15 percent.
The proportion of the population age 65 and
over varies even more by county. In 2006, 35
percent of Mclntosh County, North Dakota,
was age 65 and over, the highest proportion
in the country. In several Florida counties,
the proportion was over 30 percent. At the
other end of the spectrum was Chattahoochee
County, Georgia, with only 3 percent of its
population age 65 and over.
As in most countries of the world, older women
outnumber older men in the United States, and
the proportion that is female increases with
age. In 2006, women accounted for 58 percent
of the population age 65 and over and for 68
percent of the population age 85 and over.
The United States is fairly young for a
developed country, with just over 12 percent
of its population age 65 and over. The older
population made up more than 15 percent of
the population in most European countries
and nearly 20 percent in both Italy and Japan
in 2006.
Data for this indicator's charts and bullets
can be found in Tables la, Ib, Ic, Id, le, and
If on pages 74-77.
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INDICATOR 2
As the older population grows larger, it will also grow more diverse, reflecting the demographic changes
in the U.S. population as a whole over the last several decades. By 2050, programs and services for
older people will require greater flexibility to meet the needs of a more diverse population.
Population age 65 and over, by race and Hispanic origin, 2006 and projected
2050
Percent
100
90
80
70
60
50
40
30
20
10
2006 • 2050 (projected)
Non-Hispanic white
alone
Black alone
Asian alone
All other races alone
or in combination
18
Hispanic
(of any race)
Note: The term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are not Hispanic. The
term "black alone" is used to refer to people who reported being black or African American and no other race, and the term "Asian alone" is used
to refer to people who reported only Asian as their race. The use of single-race populations in this report does not imply that this is the preferred
method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. The race group "All other races alone or in
combination" includes American Indian and Alaska Native, alone; Native Hawaiian and Other Pacific Islander, alone; and all people who reported
two or more races.
Reference population: These data refer to the resident population.
Source: U.S. Census Bureau, Population Estimates and Projections.
In 2006, non-Hispanic whites accounted for
81 percent of the U.S. older population. Blacks
made up 9 percent, Asians made up 3 percent,
and Hispanics (of any race) accounted for 6
percent of the older population.
Projections indicate that by 2050 the com-
position of the older population will be 61
percent non-Hispanic white, 18 percent
Hispanic, 12 percent black, and 8 percent
Asian.
The older population among all racial and
ethnic groups will grow; however, the older
Hispanic population is projected to grow the
fastest, from just over 2 million in 2005 to 15
million in 2050, and to be larger than the older
black population by 2028. The older Asian
population is also projected to experience a
large increase. In 2006, just over 1 million
older Asians lived in the United States; by
2050 this population is projected to be almost
7 million.
Data for this indicator's chart and bullets can
be found in Table 2 on page 77.
1900
1910 1920 1930 1940
1950 1960
1970
1980 1990 2000
2050
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INDICATORS
Marital Status
Marital status can strongly affect one's emotional and economic well-being. Among other factors, it
influences living arrangements and the availability of caregivers for older Americans with an illness or
disability.
Marital status of the population age 65 and over, by age group and sex, 2007
• 65-74 • 75-84 • 85 and over
Percent
100r
90
80
70
60
50
40
30
20
10
0
Men
Never
married
Divorced Widowed Married
Percent
100r
90
80
70
60
50
40
30
20
10
0
Women
Never
married
Divorced Widowed Married
Note: Married includes married, spouse present; married, spouse absent; and separated.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
In 2007, older men were much more likely
than older women to be married. Over three-
quarters (78 percent) of men age 65-74 were
married, compared with over one-half (57
percent) of women in the same age group. The
proportion married is lower at older ages: 38
percent of women age 75-84 and 15 percent
of women age 85 and over were married. For
men, the proportion married also is lower at
older ages but not as low as for older women.
Even among the oldest old, the majority of
men were married (60 percent).
Widowhood is more common among older
women than older men. Women age 65 and
over were three times as likely as men of the
same age to be widowed, 42 percent compared
with 13 percent. The proportion widowed
is higher at older ages, and the proportion
widowed is higher for women than men. In
2007, 76 percent of women age 85 and over
were widowed, compared with 34 percent of
men.
Relatively small proportions of older men
(8 percent) and women (10 percent) were
divorced in 2007. A small proportion of the
older population had never married.
All comparisons presented for this indicator
are significant at 0.10 confidence level. Data
for this indicator's chart and bullets can be
found in Table 3 on page 78.
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INDICATOR 4
Educational Attainment
Educational attainment influences socioeconomic status, which in turn plays a role in well-being at
older ages. Higher levels of education are usually associated with higher incomes, higher standards of
living, and above-average health.
Educational attainment of the population age 65 and over, selected years
1965-2007
Percent
100
90
80
70
60
50
40
30
20
10
High school graduate or more
Bachelor's degree or more
I I I I I I
1965
1970
1975
1980
1985
1990
1995
2000
2005 I
2007
Note: A single question which asks for the highest grade or degree completed is now used to determine educational attainment. Prior to 1995,
educational attainment was measured using data on years of school completed.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
In 1965, 24 percent of the older population
had graduated from high school, and only 5
percent had at least a bachelor's degree. By
2007, 76 percent were high school graduates,
and 19 percent had a bachelor's degree or
more.
In 2007, about 76 percent of both older
men and older women had at least a high
school diploma. Older men attained at least
a bachelor's degree more often than older
women (25 percent compared with 15
percent). The gender gap in completion of a
college education will narrow in the future
because men and women in younger cohorts
are earning college degrees at roughly the
same rate.
1900
1910
1920
1930 1940
1950
1960 1970
1980
1990
2000 2010
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INDICATOR 4
Educational Attainment continued
Educational attainment of the population age 65 and over, by race and
Hispanic origin, 2007
Percent
100
90
80
70
60
50
40
30
20
10
0
High school graduate or more
81
76
Bachelor's degree or more
72
42
Total
Non-Hispanic
white alone
Black alone
Asian alone
Hispanic
(of any race)
Note: The term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are not
Hispanic. The term "black alone" is used to refer to people who reported being black or African American and no other race, and the
term "Asian alone" is used to refer to people who reported only Asian as their race. The use of single-race populations in this report does
not imply that this is the preferred method of presenting or analyzing data.The U.S. Census Bureau uses a variety of approaches.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
Despite the overall increase in educational
attainment among older Americans, substan-
tial educational differences exist among
racial and ethnic groups. In 2007, 81 percent
of non-Hispanic whites age 65 and over had
completed high school. Older Asians also
had a high proportion with at least a high
school education (72 percent). In contrast, 58
percent of older blacks and 42 percent of older
Hispanics had completed high school.
In 2007, older Asians had the highest pro-
portion with at least a bachelor's degree (32
percent). Almost 21 percent of older non-
Hispanic whites had this level of education.
The proportions were 10 percent and 9 percent,
respectively, for older blacks and Hispanics.
All comparisons presented for this indicator
are significant at 0.10 confidence level. Data
for this indicator's charts and bullets can be
found in Tables 4a and 4b on page 78.
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INDICATORS
Living Arrangements
The living arrangements of America's older population are important indicators because they are linked
to income, health status, and the availability of caregivers. Older people who live alone are more likely
than older people who live with their spouses to be in poverty.
Living arrangements of the population age 65 and over, by sex and race and
Hispanic origin, 2007
Percent
100
90
80
70
60
50
40
30
20
10
0
Total Non-Hispanic Black
white alone alone
With spouse • With other relatives • With nonrelatives • Alone
Men Percent Women
100
90
80
70
60
50
40
30
20
10
0
Asian Hispanic
alone (of any race)
Total Non-Hispanic Black
white alone alone
Asian Hispanic
alone (of any race)
Note: Living with other relatives indicates no spouse present. Living with nonrelatives indicates no spouse or other relatives present.The term
"non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are not Hispanic.The term "black
alone" is used to refer to people who reported being black or African American and no other race, and the term "Asian alone" is used to refer to
people who reported only Asian as their race.The use of single-race populations in this report does not imply that this is the preferred method
of presenting or analyzing data.The U.S. Census Bureau uses a variety of approaches.
Reference population:These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
Older men were more likely to live with their
spouse than were older women. In 2007, 73
percent of older men lived with their spouse
while less than one-half (42 percent) of
older women did. In contrast, older women
were more than twice as likely as older men
to live alone (39 percent and 19 percent,
respectively).
Living arrangements of older people differ-
ed by race and Hispanic origin. Older black,
Asian, and Hispanic women were more likely
than non-Hispanic white women to live with
relatives other than a spouse. For example,
in 2007, 30 percent of older Asian women,
32 percent of older black women, and 33
percent of older Hispanic women, compared
with only 14 percent of older non-Hispanic
white women, lived with other relatives.
Older non-Hispanic white women and black
women were more likely than women of other
races to live alone (about 40 percent each,
compared with 20 percent for older Asian
women and 26 percent for older Hispanic
women). Older black men lived alone more
than three times as often as older Asian men
(29 percent compared with 8 percent). Older
Hispanic men were more likely (17 percent)
than men of other races and ethnicities to live
with relatives other than a spouse.
All comparisons presented for this indicator
are significant at 0.10 confidence level. Data
for this indicator's chart and bullets can be
found in Tables 5a, 5b, and 7b on pages 79
and 82.
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INDICATOR 6
Older Veterans
Veteran status of America's older population is associated with higher median family income, lower
percentage of uninsured or coverage by Medicaid, higher percentage of functional limitations in
activities of daily living or instrumental activities of daily living, greater likelihood of having any
disability, and less likelihood of rating their general health status as good or better.4 The large increase
in the oldest segment of the veteran population will continue to have significant ramifications on the
demand for health care services, particularly in the area of long-term care.5
Percentage of people age 65 and over who are veterans, by sex and age group,
United States and Puerto Rico, 1990, 2000, and projected 2010
Percent
100
90
80
70
60
50
40
30
20
10
0
Men
1990 • 2000 • 2010 (projected)
Percent
100
90
64
54
Women
2 2
65 and over 65-74
75-84 85 and over
65 and over 65-74
75-84 85 and over
Reference population: These data refer to the resident population of the United States and Puerto Rico.
Source: U.S.Census Bureau, Decennial Census and Population Projections; Department of Veterans Affairs, VetPop2004.
According to Census 2000, there were 9.7
million veterans age 65 and over in the United
States and Puerto Rico. Two of three men age
65 and over were veterans.
More than 95 percent of veterans age 65 and
over are male. Because of the large Korean
War and WWII veteran cohorts, the number of
male veterans age 65 and over increased from
7.0 million in 1990 to 9.4 million in 2000.
The increase in the proportion of men age 85
and over who are veterans is striking. The
number of men age 85 and over who are
veterans has more than doubled between 1990
and 2000 from 150,000 to 400,000 and is
projected to reach almost 1.2 million by 2010.
The proportion of men age 85 and over who
are veterans is projected to increase from 33
percent in 2000 to 60 percent in 2010.
Between 2000 and 2010, the number of
female veterans age 85 and over is projected
to increase from about 30,000 to 95,000.
Data for this indicator's chart and bullets can
be found in Tables 6a and 6b on page 80.
1900
1910 1920 1930 1940 1950 1960 1970
1980 1990 2000
2010
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-------
Economics
Indicator 7: Poverty
Indicator 8: Income
Indicator 9: Sources of Income
Indicator 10: Net Worth
Indicator 11: Participation in the Labor Force
Indicator 12: Total Expenditures
Indicator 13: Housing Problems
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INDICATOR 7
Poverty
Poverty rates offer one way to evaluate economic well-being. The official poverty definition is based
on annual money income before taxes and does not include capital gains and noncash benefits. To
determine who is poor, the U.S. Census Bureau compares family income (or an unrelated individual's
income) with a set of poverty thresholds that vary by family size and composition and are updated
annually for inflation. People identified as living in poverty are at risk of having inadequate resources
for food, housing, health care, and other needs.
Poverty rate of the population, by age group, 1959-2006
Percent
100i-
90
80
70
60
50
40
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
1959
1964
1969
1974
1979
1984
1989
1994
1999
Z Data are not available from 1960—1965 for the 18—64 and 65 and over age groups.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1960—2007.
2004 I
2006
In 1959, 35 percent of people age 65 and over
lived below the poverty threshold. By 2006,
the proportion of the older population living
in poverty had decreased dramatically to 9
percent.
Relative levels of poverty among the different
age groups have changed over time. In 1959,
older people had the highest poverty rate (35
percent), followed by children (27 percent)
and those in the working ages (17 percent). By
2006, the proportions of the older population
and those of working age living in poverty
were 9 percent and 11 percent respectively,
while 17 percent of children lived in poverty.
Poverty rates differed by age and sex among
the older population. Older women (12 percent)
were more likely than older men (7 percent) to
live in poverty in 2006. People age 65-74 had
a poverty rate of 9 percent, compared with 10
percent of those age 75 and over.
Race and ethnicity are related to poverty
among the older population. In 2006, older
non-Hispanic whites were far less likely than
older blacks and older Hispanics to be living
in poverty—about 7 percent compared with
23 percent of older blacks and 19 percent of
older Hispanics (not a statistically significant
difference between the latter two groups).
Older non-Hispanic white and black women
had higher poverty rates than their male
counterparts.
All comparisons presented for this indicator
are significant at 0.10 confidence level. Data
for this indicator's chart and bullets can be
found in Tables 7a and 7b on pages 81-82.
1900
1910
1920 1930
1940
1950 1960
1970
1980 1990 2000 2010
-------
INDICATORS
Income
The percentage of people living below the poverty line does not give a complete picture of the economic
situation of older Americans. Examining the income distribution of the population age 65 and over and
their median income provides additional insights into their economic well-being.
Income distribution of the population age 65 and over, 1974-2006
Percent
100
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Note: The income categories are derived from the ratio of the family's income (or an unrelated individual's income) to the corresponding
poverty threshold. Being in poverty is measured as income less than 100 percent of the poverty threshold. Low income is between 100
percent and 199 percent of the poverty threshold. Middle income is between 200 percent and 399 percent of the poverty threshold. High
income is 400 percent or more of the poverty threshold.
Reference population:These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1975-2007.
Since 1974, the proportion of older people
living in poverty and in the low-income group
has generally declined so that, by 2006, 9
percent of the older population lived in poverty
and 26 percent of the older population were in
the low-income group.
In 2006, people in the middle income group
made up the largest share of older people by
income category (36 percent). The proportion
with a high income has increased over time.
The proportion of the older population having
a high income rose from 18 percent in 1974 to
29 percent in 2006.
The trend in median household income of
the older population has also been positive.
In 1974, the median household income for
householders age 65 and over was $19,086
when expressed in 2006 dollars. By 2006, the
median household income had increased to
$27,798.
All comparisons presented for this indicator
are significant at 0.10 confidence level. Data
for this indicator's chart and bullets can be
found in Tables 8a and 8b on pages 83-84.
1900 1910
1920 1930 1940 1950 1960 1970
1980
1990 2000 2010
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INDICATOR 9
Sources of Income
Most older Americans are retired from full-time work. Social Security was developed as a floor of
protection for their incomes, to be supplemented by other pension income, income from assets, and to
some extent, continued earnings. Over time, Social Security has taken on a greater importance to many
older Americans.
Distribution of sources of income for married couples and nonmarried people
who are age 65 and over, selected years 1962-2006
Percent
100
90
80
70
60
50
40
30
20
10
Percent
100
Other
Earnings
Pensions
Asset income
Social Security
1962
1967
1976 1980
1990
2000
2005
2006
Note: A married couple is age 65 and over if the husband is age 65 and over or the husband is younger than age 55 and the wife is age 65 and
over.The definition of "other" includes, but is not limited to, public assistance, unemployment compensation, worker's compensation, alimony,
child support,and personal contributions.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Social Security Administration, 1963 Survey of the Aged, 1968 Survey of Demographic and Economic Characteristics of the Aged; U.S.
Census Bureau,Current Population Survey, Annual Social and Economic Supplement, 1977-2007.
Since the early 1960s, Social Security has
provided the largest share of aggregate
income for older Americans. The share of
income from pensions increased rapidly in
the 1960s and 1970s and more gradually since
then. The share of income from assets peaked
in the mid-1980s and has generally declined
since then. The share from earnings has had
the opposite pattern—declining until the mid-
1980s and generally increasing since then.
In 2006, aggregate income for the population
age 65 and over came largely from four sources.
Social Security provided 37 percent, earnings
accounted for 28 percent, pensions provided
18 percent, and asset income accounted
for 15 percent.
Ninety percent of people age 65 and over live
in families with income from Social Security.
Sixty percent are in families with income from
assets, and almost one-half (45 percent) with
income from pensions. About one-third (36
percent) are in families with earnings and 1 in
20 are in families receiving public assistance.
Pension coverage expanded dramatically
in the 2 decades after World War II, and
private pensions accounted for an increasing
proportion of income for older people during
the 1960s and early 1970s. Since then, the
coverage rate has been stable at about 50
percent of all private workers on their jobs.6'7
1900
1910
1920
1930 1940
1950
1960 1970
1980
1990 2000 2010
-------
INDICATOR 9
Sources of Income continued
Sources of income for married couples and nonmarried people who are
age 65 and over, by income quintile, 2006
Other
Lowest fifth
Second fifth
Third fifth
Income Level
Fourth fifth
Highest fifth
Note: A married couple is age 65 and over if the husband is age 65 and over or the husband is younger than age 55 and the wife is age 65 and
over. The definition of "other" includes, but is not limited to, unemployment compensation, worker's compensation, alimony, child support, and
personal contributions. Quintile limits are $11,519 for the lowest quintile, $18,622 for the second quintile, $28,911 for the third quintile, $50,064
for the fourth qunitile, and open-ended for the highest quintile.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2007.
There has been a major shift in the type
of pensions provided by employers, from
defined-benefit plans (in which a specified
amount is typically paid as a lifetime annuity)
to defined-contribution plans such as 401(k)
plans (in which the amount of the benefit var-
ies depending on investment returns). Em-
ployers increasingly offer defined-contribution
plans to employees. The percentage of private
workers who participated in defined-benefit
plans decreased from 32 percent in 1992-
1993 to 21 percent in 2005.7 Over the same
period, participation in defined-contribution
plans increased from 35 percent to 42 percent.
In recent years, a growing number of em-
ployers have converted their defined-benefit
plans to cash balance plans.
Among married couples and nonmarried
people age 65 and over in the lowest fifth of the
income distribution, Social Security accounts
for 83 percent of aggregate income, and public
assistance accounts for another 8 percent. For
those whose income is in the highest income
category, Social Security, pensions, and asset
income each account for about one-fifth of
aggregate income, and earnings account for
the remaining two-fifths.
For the population age 80 and over, a larger
percentage of people lived in families with
Social Security income (95 percent) and
smaller percentage with earnings (20 percent),
compared with the population age 65-69 (85
percent and 53 percent, respectively).
Data for this indicator's charts and bullets
can be found in Tables 9a, 9b, and9c on pages
85-86.
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INDICATOR 10
Net Worth
Net worth (the value of real estate, stocks, bonds, and other assets minus outstanding debts) is an
important indicator of economic security and well-being. Greater net worth allows a family to maintain
its standard of living when income falls because of job loss, health problems, or family changes such
as divorce or widowhood.
Median household net worth, by race of head of household age 65 and over,
in 2005 dollars, selected years 1984-2005
Dollars, in thousands
500
450
400
350
300
250
200
150
100
50
White
Black
0
1984
1989
1994
1999
2001
2003
2005
Note: Net worth data do not include pension wealth. This excludes private defined-contribution and defined-benefit plans as well as rights to
Social Security wealth. Data for 1984-2003 have been inflation adjusted to 2005 dollars. See Appendix B for the definition of race and Hispanic
origin in the Panel Study of Income Dynamics.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Panel Study of Income Dynamics.
Between 1984 and 2005, the median net
worth of households headed by white people
age 65 and over increased 81 percent from
$125,000 to $226,900. The median net worth
of households headed by black people age 65
and over increased 34 percent from $28,200
to $37,800.
In 1984, the median net worth of households
headed by white people age 65 and over was
4 times that of households headed by black
people. In 2005, the median net worth of
older white households was 6 times that of
older black households. This difference is less
than it was in 2003 when the median net worth
of households headed by older white people
was 8 times higher than that of households
headed by older black people.
In 2005, the median net worth of households
headed by married people age 65 and over
($328,300) was more than three times that
of households headed by unmarried people
($104,000) in the same age group.
Overall, between 1984 and 2005, the median
net worth of households headed by people age
65 and over increased by 79 percent (from
$109,000 to $196,000).
1900
1910
1920
1930
1940
1950
1960 1970
1980
1990
2000 2010
-------
INDICATOR 10
Net Worth continued
Median household net worth, by educational attainment of head of household
age 65 and over, in 2005 dollars, selected years 1984-2005
Dollars, in thousands
500 r
450
400
350
300
250
200
150
100
50
0
Some college or more
High school diploma only
No high school diploma
1984
1989
1994
1999
2001
2003
2005
Note: Net worth data do not include pension wealth. This excludes private defined-contribution and defined-benefit plans as well as rights to
Social Security wealth. Data for 1984-2003 have been inflation adjusted to 2005 dollars.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Panel Study of Income Dynamics.
In 2005, households headed by people age
65 over with some college or more reported a
median household net worth ($412,100) more
than six times that of households headed by
older people without a high school diploma
($59,500).
Between 1984 and 2005, the median net worth
of households headed by people age 65 and
over without a high school diploma remained
approximately the same, while the median
net worth of households headed by people
with some college or more increased by 72
percent.
Data for this indicator's charts and bullets
can be found in Table 10 on page 87.
1900 1910 1920 1930 1940 1950 1960 1970
1980 1990 2000 2010
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INDICATOR 11
Participation in the Labor Force
The labor force participation rate is the percentage of a group that is in the labor force—that is, either
working (employed) or actively looking for work (unemployed). Some older Americans work out of
economic necessity. Others may be attracted by the social contact, intellectual challenges, or sense of
value that work often provides.
Labor force participation rates of men age 55 and over, by age group, annual
averages, 1963-2006
Percent
100
90
80
70
60
50
40
30
20
10
55-61
1963
1968
1973
1978
1983
1988
1993
1998
2003 2006
Note: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years due to a redesign of the survey and
methodology of the Current Population Survey. Beginning in 2000, data incorporate population controls from Census 2000.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Bureau of Labor Statistics, Current Population Survey.
Between 1963 and 2006, labor force
participation rates declined from 90 percent
to 75 percent among men age 55-61. Over
this period, participation rates declined from
76 percent to 52 percent for men age 62-64
and from 21 percent to 14 percent for men age
70 and over. For these age groups, most of the
decline occurred prior to the early 1980s.
The decline in labor force participation
among older men before the 1980s has been
attributed to several factors. The youngest
age of eligibility for Social Security benefits
was reduced from 65 to 62 in the early 1960s.
Greater wealth also allowed older Americans
to retire earlier.8 The more recent stability of
participation rates has been partially explained
by the elimination of mandatory retirement
laws, liberalization of the Social Security
earnings test (the reduction of Social Security
benefits as earnings exceed specified amounts),
and gradual increases in the delayed retirement
credit for Social Security beneficiaries.9
While men age 65-69 also experienced an
overall decline in labor force participation
from 1963 to the mid-1980s, this group has
gradually increased its participation rate in
more recent years. The labor force participation
rate for men age 65-69 showed a gradual
decline from about 43 percent in the late 1960s
to 24 percent in 1985. Their participation rate
leveled off from the mid-1980s to the early
1990s, holding in the 24 percent to 26 percent
range. From 1993 to 2006, the rate increased
from 25 percent to 34 percent.
1900
1910
1920
1930 1940
1950
1960 1970
1980
1990 2000 2010
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INDICATOR 11
Participation in the Labor Force continued
Labor force participation rates of women age 55 and over, by age group, annual
averages, 1963-2006
Percent
100
1963
1968
1973
1978
1983
1988
1993
1998
2003 2006
Note: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years due to a redesign of the survey and
methodology of the Current Population Survey. Beginning in 2000, data incorporate population controls from Census 2000.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Bureau of Labor Statistics, Current Population Survey.
Labor force participation rates have risen
among women age 55 years and over during
the past 4 decades. The increase has been
largest among women age 55-61, from 44
percent in 1963 to nearly 64 percent in 2006.
with a majority of the increase occurring after
1985. For women age 62-64, 65-69, and 70
years and over, most of the increase in their
participation rates began in the mid-1990s.
Labor force participation rates for older
women reflect changes in the work experience
of successive generations of women. Many
women now in their 60s and 70s did not work
outside the home when they were younger, or
they moved in and out of the labor force. As
new cohorts of women approach older ages,
they are participating in the labor force at
higher rates than previous generations. As a
result, in 2006, nearly 64 percent of women
age 55-61 were in the labor force, compared
with 44 percent of women age 55-61 in
1963. Over the same period, the labor force
participation rate increased from 29 percent
to 42 percent among women age 62-64 and
from 17 percent to 24 percent among women
age 65-69.
The difference between labor force partici-
pation rates for men and women has narrowed
over time. Among people age 55-61, for
example, the gap between men's and women's
rates in 2006 was 11 percentage points,
compared with 46 percentage points in 1963.
Data for this indicator's charts and bullets
can be found in Table 11 on page 88.
1900
1910
1920 1930
1940
1950 1960
1970
1980
1990 2000 2010
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INDICATOR 12
Total Expenditures
Expenditures are another indicator of economic well-being that show how the older population allocates
resources to food, housing, health care, and other needs. Expenditures may change with changes in
work status, health status, or income.
Percentage of total household annual expenditures by age of reference
person, 2005
Other
Food
Housing
Transportation
Healthcare
Personal insurance and pensions
55-64
65 and
over
65-74
75 and
over
Note: Other expenditures include apparel, personal care, entertainment, reading, education, alcohol, tobacco, cash contributions, and miscella-
neous expenditures. Data from the Consumer Expenditure Survey by age group represent average annual expenditures for consumer units by the
age of reference person, who is the person listed as the owner or renter of the home. For example, the data on people age 65 and over reflect
consumer units with a reference person age 65 or older.The Consumer Expenditure Survey collects and publishes information from consumer
units, which are generally defined as a person or group of people who live in the same household and are related by blood, marriage, or other legal
arrangement (i.e., a family), or people who live in the same household but who are unrelated and financially independent from one another (e.g.,
roommates sharing an apartment). A household usually refers to a physical dwelling, and may contain more than one consumer unit. However,for
convenience the term "household" is substituted for "consumer unit" in this text.
Reference population: These data refer to the resident noninstitutionalized population.
Source: Bureau of Labor Statistics, Consumer Expenditure Survey.
Households headed by people age 65 and over
allocated about 34 percent of their total annual
expenditures to housing expenses, the largest
single component of annual expenditures.
Transportation expenses accounted for about
16 percent of total spending. Food accounted
for about 13 percent of total spending.
About 13 percent of all expenditures in house-
holds headed by people age 65 and over
were on healthcare expenses, which includes
health insurance, medical services, drugs,
and medical supplies. In comparison, the
proportion of total expenditures on healthcare
among households headed by people age 55-
64 was 7 percent.
Households headed by people age 55-64,
allocated a larger share of total expenditures
(12 percent) to personal insurance and pensions
(including Social Security payroll taxes) than
those headed by people age 65 and over
(5 percent).
Data for this indicator's chart and bullets can
be found in Table 12 on page 89.
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INDICATOR 13
Housing Problems
Most older people live in adequate, affordable housing. For some, however, costly or physically inade-
quate housing can pose serious problems to an older person's physical or psychological well-being.
Percentage of all U.S. households and households with residents age 65 and over
that report housing problems, by type of problem, selected years 1985-2005
Percent
100 r
90
80
70
60
50
40
30
20
10
• Housing problem(s), All
'Cost burden, All
Physically inadequate housing, 65+
Cost burden, 65+
- Physically inadequate housing, All
^•^^H^^^^^^^^^^^^^^^^^^^^^^^B
J I I I
1985
1989
1995
1997
1999
2001
2003
2005
(All) All U.S. households; (65+) U.S. households with one or more residents age 65 and over.
"Although crowded housing is not a common problem for older people (less than 1 percent), it is included as one of three possible housing
problems under "housing problem(s)." See Tables 13a and 13b in Appendix A for more information.
Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes
are excluded.
Source: Department of Housing and Urban Development, American Housing Survey.
In 2005, 41 percent of households with
people age 65 and over had one or more of
the following types of housing problems:
housing cost burden, physically inadequate
housing, and/or crowded housing. This is the
highest level since 1985. By comparison, the
occurrence of such problems among all U.S.
households was 37 percent in 2005.
The prevalence of housing cost burden, or
expenditures on housing and utilities that
exceeds 30 percent of household income, has
increased for all U.S. households but is more
prevalent among the households with people
age 65 and over. Between 1985 and 2005,
housing cost burden for households with older
people increased from 30 percent to 38 percent.
By comparison, the prevalence of housing cost
burden among all U.S. households increased
from 26 percent in 1985 to 33 percent in
2005.
Physically inadequate housing, or housing with
severe or moderate physical problems such as
lacking complete plumbing or having multiple
upkeep problems, has become less common.
In 2005, 5 percent of households with people
age 65 and over had inadequate housing,
compared with 8 percent in 1985. In contrast,
6 percent of U.S. households overall reported
living in physically inadequate housing
during 2005 compared with 8 percent in 1985.
Data for this indicator's chart and bullets
can be found in Tables 13a and 13b on pages
89-92.
1900
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
-------
-------
Health Status
Indicator 14: Life Expectancy
Indicator 15: Mortality
Indicator 16: Chronic Health Conditions
Indicator 17: Sensory Impairments and Oral Health
Indicator 18: Respondent-Assessed Health Status
Indicator 19: Depressive Symptoms
Indicator 20: Functional Limitations
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INDICATOR 14
Life Expectancy
Life expectancy is a summary measure of the overall health of a population. It represents the average
number of years of life remaining to a person at a given age if death rates were to remain constant. In
the United States, improvements in health have resulted in increased life expectancy and contributed to
the growth of the older population over the past century.
Life expectancy at ages 65 and 85, by sex, selected years 1900-2004
Years of life
25 r
20
15
10
Men, at age 65
Women, at age 85
lnil
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000 |
2004
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
Americans are living longer than ever before.
Life expectancies at both age 65 and age
85 have increased. Under current mortality
conditions, people who survive to age 65 can
expect to live an average of 18.7 more years,
almost 7 years longer than people age 65 in
1900. The life expectancy of people who
survive to age 85 today is 7.2 years for women
and 6.1 years for men.
Life expectancy varies by race, but the
difference decreases with age. In 2004, life
expectancy at birth was 5.2 years higher for
white people than for black people. At age 65,
white people can expect to live an average of
1.6 years longer than black people. Among
those who survive to age 85, however, the life
expectancy among black people is slightly
higher (7.1 years) than white people (6.7
years).
Life expectancy at age 65 in the United States
is lower than that of many other industrialized
nations. In 2003, women age 65 in Japan could
expect to live on average 3.2 years longer than
women in the United States. Among men, the
difference was 1.2 years.
1900
1910
1920
1930
1940
1950 1960
1970
1980 1990 2000 2010
-------
INDICATOR 14
Life Expectancy continued
Average life expectancy for women at age 65, by selected countries or areas,
selected years 1980-2003
Years of life
25
20
15
10
• England & Wales
0
1980 1990 2000
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Health, UnitedStates, 2007.]0
2003
Average life expectancy for men at age 65, by selected countries or areas,
selected years 1980-2003
Years of life
25 r
20
15
10
-France
• United States
I
England & Wales
I
0
1980 1990 2000
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2007}°
2003
Data for this indicator's charts and bullets can
be found in Tables 14a, 14b, and 14c on pages
93-94.
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
-------
INDICATOR 15
Mortality
Overall, death rates in the U.S. population have declined during the past century. But for some diseases.
death rates among older Americans have increased in recent years.
Death rates for selected leading causes of death among people age 65 and
over, 1981-2004
ICD-10
Per 100,000 V
3,000 1-
2,750
2,500
2,250
2,000
1,750
1,500
1,250
1,000
750
500
250
0
19
-
^ —
"**1**^»—
-
-
-
:
w Influenza and pneumonia
81 1985
^^^ w Diseases of heart
^ :::_^^^
^—
Y Malignant neoplams
_ yCerebrovascular diseases
Chronic lower respiratory diseases*^
1990 1995
.^^Alzheimer's disease^F
2000 2004
Note: Death rates for 1981 -1998 are based on the 9th revision of the International Classification of Diseases (\CD-9). Starting in
1 999, death rates are based on ICD-1 0 and trends in death rates for some causes may be affected by this change.1 ' For the period
1 981 -1 998, causes were coded using ICD-9 codes that are most nearly comparable with the 1 1 3 cause list for the ICD-1 0 and may
differ from previously published estimates. Rates are age adjusted using the 2000 standard population.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
In 2004, the leading cause of death among
people age 65 and over was diseases of heart
(heart disease) (1,418 deaths per 100,000
people), followed by malignant neoplasms
(cancer) (1,052 per 100,000), cerebrovascular
diseases (stroke) (346 per 100,000), chronic
lower respiratory diseases (284 per 100,000),
Alzheimer's disease (171 per 100,000),
diabetes mellitus (146 per 100,000), and
influenza and pneumonia (139 per 100,000).
Between 1981 and 2004, age adjusted death
rates for all causes of death among people age
65 and over declined by 18 percent. Death
rates for heart disease and stroke declined by
approximately 44 percent. Age adjusted death
rates for diabetes increased by 38 percent
since 1981, and death rates for chronic lower
respiratory diseases increased by 53 percent.
Heart disease and cancer are the top two
leading causes of death among all people
age 65 and over, irrespective of sex, race, or
Hispanic origin.
Other causes of death vary among older
people by sex and race and Hispanic origin.
For example, men have much higher suicide
rates than those of women at all ages, with the
largest difference occurring at age 85 and over
(45 deaths per 100,000 population for men
compared with 4 per 100,000 for women).
Non-Hispanic white men age 85 and over
have the highest rate of suicide overall at 50
deaths per 100,000.12
Data for this indicator's chart and bullets can
be found in Tables 15a, 15b, and 15c on pages
95-99.
1900
1910
1920 1930
1940
1950 1960
1970
1980
1990 2000 2010
-------
INDICATOR 16
Chronic Health Conditions
Chronic diseases are long-term illnesses that are rarely cured. Chronic diseases such as heart disease.
stroke, cancer, and diabetes are among the most common and costly health conditions.13 Chronic health
conditions negatively affect quality of life, contributing to declines in functioning and the inability to
remain in the community.14 Many chronic conditions can be prevented or modified with behavioral
interventions. Six of the seven leading causes of death among older Americans are chronic diseases.
(See "Indicator 15: Mortality.")
Percentage of people age 65 and over who reported having selected chronic
conditions, by sex, 2005-2006
Percent
100
90
80
70
60
50
40
Men
I Women
54
- 37
30
20
10
Heart Hyper- Stroke Asthma Chronic Any Diabetes
disease tension bronchitis or cancer
Emphysema
Note: Data are based on a 2-year average from 2005-2006.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Arthritis
The prevalence of certain chronic conditions
differs by sex. Women report higher levels of
arthritis than men. Men report higher levels of
heart disease and cancer.
There are differences by race and ethnicity in
the prevalence of certain chronic conditions.
In 2005-2006, among people age 65 and over,
non-Hispanic blacks report higher levels of
hypertension and diabetes than non-Hispanic
whites (70 percent compared with 51 percent
for hypertension and 29 percent compared
with 16 percent for diabetes). Hispanics
also report higher levels of diabetes than
non-Hispanic whites (25 percent compared
with 16 percent), but similar levels of
hypertension (54 percent and 51 percent,
respectively) and lower levels of arthritis
(40 percent compared with 50 percent).
Data for this indicator's chart and bullets can
be found in Tables 16a and 16b on page 100.
-------
INDICATOR 17
Sensory Impairments and Oral Health
Vision and hearing impairments and oral health problems are often thought of as natural signs of aging.
Often, however, early detection and treatment can prevent, or at least postpone, some of the debilitating
physical, social, and emotional effects these impairments can have on the lives of older people. Glasses,
hearing aids, and regular dental care are not covered services under Medicare.
Percentage of people age 65 and over who reported having any trouble hearing,
any trouble seeing, or no natural teeth, by sex, 2006
Percent
100r
90
80
70
60
50
40
30
20
10
Men
I Women
27
25
Any trouble hearing
Any trouble seeing
No natural teeth
Note: Respondents were asked "Which statement best describes your hearing without a hearing aid: good, a little trouble, a lot of trouble, deaf?"
For the purposes of this indicator the category "Any trouble hearing"includes "a little trouble, a lot of trouble, and deaf." Regarding their vision,
respondents were asked "Do you have any trouble seeing, even when wearing glasses or contact lenses?" The category "Any trouble seeing" also
includes those who in a subsequent question report themselves as blind. Lastly, respondents were asked, in one question,"Have you lost all of
your upper and lower natural (permanent) teeth?"
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
+ In 2006, close to one-half of older men and
more than one-third of older women reported
trouble hearing. The percentage with trouble
hearing was higher for people age 85 and over
(62 percent) than for people age 65-74 (32
percent). Ten percent of all older women and
18 percent of all older men reported having
ever worn a hearing aid.
+ Vision trouble affects 17 percent of the older
population, 16 percent of men and 18 percent
of women. Among people age 85 and over, 27
percent reported trouble seeing.
The prevalence of edentulism, having no
natural teeth, was higher for people age 85 and
over (32 percent) than for people age 65-74
(23 percent). Socioeconomic differences are
large. Thirty-nine percent of older people with
family income below the poverty line reported
no natural teeth compared with 26 percent of
people above the poverty threshold.
Data for this indicator's charts and bullets
can be found in Tables 17a and 17b on page
101.
-------
INDICATOR 18
Respondent-Assessed Health Status
Asking people to rate their health as excellent, very good, good, fair, or poor provides a common
indicator of health easily measured in surveys. It represents physical, emotional, and social aspects
of health and well-being. Respondent-assessed health ratings of poor correlate with higher risks of
mortality.15
Percentage of people age 65 and over who reported having good to excellent
health, by age group and race and Hispanic origin, 2004-2006
Percent
100
90
80
70
60
50
40
30
20
10
0
Non-Hispanic
white
Non-Hispanic
black
74
Hispanic
(of any race)
67
47
65 and over
65-74
75-84
85 and over
Note: Data are based on a 3-year average from 2004-2006. See Appendix B for the definition of race and Hispanic origin in the National Health
Interview Survey
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
During the period 2004-2006, 74 percent
of people age 65 and over rated their health
as good or better. This has been true for the
decades preceding 2004 as well; the majority
of older people reported their health to be
good to excellent.
The proportion of people reporting good to
excellent health decreases among the older
age groups. Among men, 78 percent of those
age 65-74 report good or better health. At age
85 and over, 63 percent of men report good or
better ratings. This pattern is evident among
women and within race and ethnic groups.
Regardless of age, older non-Hispanic white
men and women are more likely to report
good health than their non-Hispanic black and
Hispanic counterparts. Non-Hispanic blacks
and Hispanics are similar to one another in
their positive health evaluations, although
among men age 85 and over, Hispanics have
the lowest health ratings
Data for this indicator's chart and bullets can
be found in Table 18 on page 102.
-------
INDICATOR 19
Depressive Symptoms
Depressive symptoms are an important indicator of general well-being and mental health among older
adults. People who report many depressive symptoms often experience higher rates of physical illness.
greater functional disability, and higher health care resource utilization.16'17
Percentage of people age 65 and over with clinically relevant depressive
symptoms, by sex, 1998-2004
Percent
100i-
90
80
70
60
50
40
30
20
10
0
Men
12
1998
2000
2002
2004
Percent
100
90
80
70
60
50
40
30
20
10
0
Women
19
19
18
17
1998
2000
2002
2004
Note: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive symptoms from an
abbreviated version of the Center for Epidemiological Studies Depression Scale (CES-D) adapted by the Health and Retirement Study.The CES-
D scale is a measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the
"4 or more symptoms"cut-off can be found in the following documentation, hrsonline.isr.umich.edu/docs/userg/dr-005.pdf.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Health and Retirement Study.
Older women are more likely to report
clinically-relevant depressive symptoms than
older men. In 2004, 17 percent of women age
65 and over reported depressive symptoms
compared with 11 percent of men. There
has been no significant change in this sex
difference between 1998 and 2004.
The percentage of people reporting clinically-
relevant depressive symptoms has remained
relatively stable over the past few years.
Between 1998 and 2004, the percentage of
men who reported depressive symptoms
ranged between 11 percent and 12 percent.
The percentage of women reporting depressive
symptoms ranged between 17 and 19 percent.
1900
1910
1920
1930
1940
1950 1960
1970
1980
1990
2000 2010
-------
INDICATOR 19
Depressive Symptoms continued
Percentage of people age 65 and over with clinically relevant depressive
symptoms, by age group and sex, 2004
Percent
100
90
so
70
60
50
40
30
20
10
0
I Total
I Men
I Women
14
65 and over
65-74
75-84
85 and over
Note: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive symptoms from an
abbreviated version of the Center for Epidemiological Studies Depression Scale (CES-D) adapted by the Health and Retirement Study.The CES-
D scale is a measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the
"4 or more symptoms"cut-off can be found in the following documentation, hrsonline.isr.umich.edu/docs/userg/dr-005.pdf.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Health and Retirement Study.
The prevalence of clinically-relevant depressive
symptoms is related to age. In 2004, the
proportion of people age 65 and over with
clinically-relevant depressive symptoms was
higher for people age 85 and over (19 percent)
than for people age 65-74 (13 percent).
In 2004, the percentage of women age 85
and over reporting depressive symptoms (19
percent) was almost 20 percent higher than the
percentage of women age 65-74 (16 percent)
reporting the same depressive symptoms. The
percentage of men age 85 and over reporting
clinically-relevant depressive symptoms
(19 percent) is almost double the percentage
of men age 65-74 (10 percent) reporting
symptoms.
Serious psychological distress is another
measure of mental health. It identifies people
who have a diagnosable mental disorder (such
as schizophrenia, bipolar disorder, or severe
forms of depression) resulting in functional
impairment in major life activities.18 In
2006, 2 percent of people age 65 and over
reported experiencing symptoms of serious
psychological distress.19
Antidepressants can be an effective treatment
for the specific illness of major depressive
disorder.20 The use of antidepressants among
noninstitutionalized people age 65 and over
increased from 9 percent in 1997 to 13 percent
in 2002.21
Data for this indicator's charts and bullets can
be found in Tables 19a and 19b on page 103.
-------
INDICATOR 20
Functional Limitations
Functioning in later years may be diminished if illness, chronic disease, or injury limits physical and/
or mental abilities. Changes in functional limitation rates have important implications for work and
retirement policies, health and long-term care needs, and the social well-being of the older population.
44
42
Percentage of Medicare enrollees age 65 and over who have limitations in activi-
ties of daily living (ADLs) or instrumental activities of daily living (lADLs), or who
are in a facility, selected years 1992-2005
Percent
100
90
80
70
60
50
40
30
20
10
0
1992 1997 2001 2005
Note: The Medicare Current Beneficiary Survey has replaced the National Long Term Care Survey as the data source for this indicator.
Consequently, the measurement of functional limitations (previously called disability) has changed from previous editions of Older
Americans. A residence (or unit) is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds and is
licensed as a nursing home or other long-term care facility and provides at least one personal care service; or provides 24-hour, 7-day-a-week
supervision by a non-family, paid caregiver. ADL limitations refer to difficulty performing (or inability to perform for a health reason) one or
more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. IADL limitations refer to difficulty
performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy
housework, meal preparation, shopping, or managing money. Rates are age adjusted using the 2000 standard population. Data for 1992
and 2001 do not sum to the totals because of rounding.
Reference:These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
lADLs only
3 to 4 ADLs
5 to 6 ADLs
Facility
In 2005, more than two-fifths (42 percent) of
people age 65 and over reported a functional
limitation. Twelve percent had difficulty per-
forming one or more lADLs (but no ADL
limitation). Eighteen percent had difficulty
with 1-2 ADLs, 5 percent had difficulty with
3-4 ADLs, 3 percent had difficulty with 5-6
ADLs, and 4 percent were in a facility.
The age adjusted proportion of people age 65
and over with a functional limitation declined
from 49 percent in 1992 to 42 percent in
2005. There was a steady decrease in the
percent with limitations from 1992 until 1997.
From 1997 to 2005 the overall levels have not
significantly changed, although the decline in
facility residence has continued.
Women have higher levels of functional
limitations than men. In 2005, 47 percent of
female Medicare enrollees age 65 and over
had difficulty with ADLs or lADLs, or were
in an institution, compared with 35 percent
of male Medicare enrollees. Rates of decline
since 1992 are similar for men and women.
1900 1910
1920 1930 1940 1950 1960 1970
1980 1990 2000 2010
-------
INDICATOR 20
Functional Limitations continued
Different indicators can be used to monitor functioning, including limitations in Activities of Daily
Living (ADLs) and Instrumental Activities of Daily Living (lADLs), and measures of physical.
cognitive, and social functioning. Aspects of physical functioning such as the ability to liftheavy objects,
walk 2-3 blocks, or reach up over one's head are more closely linked to physiological capabilities than
are ADLs and lADLs, which also may be influenced by social and cultural role expectations and by
changes in technology.
Percentage of Medicare enrollees age 65 and over who are unable to perform
certain physical functions, by sex, 1991 and 2005
Percent
100
90
80
70
60
50
40
30
20
10
Men
Percent
100
90
80
70
60
50
32 32
1991
I 2005
Women
Stoop/
kneel
Reach
over
head
Write
Walk
2-3
blocks
Lift
10lbs.
Walk
2-3
blocks
Lift
10lbs.
Any of
these
five
Note: Rates for 1991 are age adjusted to the 2005 population.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Older women reported more problems with
physical functioning than older men. In 2005,
32 percent of women reported they were
unable to perform at least one of five activities,
compared with 19 percent of men.
Problems with physical functioning were
more frequent at older ages. Among men aged
65-74, 14 percent reported they were unable
to perform at least one of five activities,
compared with 38 percent of men aged 85
and over. Among women, 22 percent of those
aged 65-74 were unable to perform at least
one activity, compared with 56 percent of
those aged 85 and over.
Physical functioning was not strongly related
to race in 2005. Among men, 19 percent of
non-Hispanic whites were unable to perform
at least one activity, compared with 24 percent
of non-Hispanic blacks. Among women, there
were no significant differences among non-
Hispanic whites, non-Hispanic blacks, and
Hispanics, regarding ability to perform at
least one activity.
Data for this indicator's charts and bullets
can be found in Tables 20a, 20b, and 20c on
pages 104-105.
\_
1900 1910
1920 1930 1940 1950 1960 1970
1980 1990 2000 2010
-------
-------
Health Risks and Behaviors
Indicator 21:
Indicator 22:
Indicator 23:
Indicator 24:
Indicator 25:
Indicator 26:
Indicator 27:
Indicator 28:
Vaccinations
Mammography
Diet Quality
Physical Activity
Obesity
Cigarette Smoking
Air Quality
Use of Time
-------
INDICATOR 21
Vaccinations
Vaccinations against influenza and pneumococcal disease are recommended for older Americans.
who are at increased risk for complications from these diseases compared with younger indi-
viduals.22'23 Influenza vaccinations are given annually, and pneumococcal vaccinations are usually given
once in a lifetime. The costs associated with these vaccinations are covered under Medicare Part B.
Percentage of people age 65 and over who reported having been vaccinated
against influenza and pneumococcal disease, by race and Hispanic origin,
selected years 1989-2006
Percent
100 i-
90
80
70
60
SO
40
30
20
10
Influenz
Non-Hispanic whit
Pneumococcal disease
w Non-Hispanic black
J I
I
Pneumococcal disease
Hispanic
I I I I I I I I
I I
1989
1991
1993 1994 1995
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Note: For influenza, the percentage vaccinated consists of people who reported having a flu shot during the past 12 months and does not include
receipt of nasal spray flu vaccinations. For pneumococcal disease, the percentage refers to people who reported ever having a pneumonia
vaccination. See Appendix B for the definition of race and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
In 2006, 64 percent of people age 65 and
over reported receiving a flu shot in the past
12 months; however, there are differences by
race and ethnicity. Sixty-seven percent of non-
Hispanic whites reported receiving a flu shot
compared with 47 percent of non-Hispanic
blacks and 45 percent of Hispanics.
In 2006, 57 percent of people age 65 and over
had ever received a pneumonia vaccination.
Despite recent increases in the rates for all
groups, non-Hispanic whites were more likely
to have received a pneumonia vaccination (62
percent) compared with non-Hispanic blacks
(36 percent) or Hispanics (33 percent).
Data for this indicator fc chart and bullets can
be found in Tables 21a and 21b on page 106.
1900
1910
1920
1930
1940
1950 1960 1970 1980
1990
2000 2010
-------
INDICATOR 22
Mammography
Health care services and screenings can help prevent disease or detect it at an early, treatable stage.
Mammography has been shown to be effective in reducing breast cancer mortality among women age
40 and over, especially for the 50-69 age group.24
Percentage of women age 50 and over who had a mammogram in the past
2 years, by age group, selected years 1987-2005
Percent
100 r
90
80
70
60
50
40
30
20
10
0
1987
50-64
I
I
I
I
I
I
I
1990 1991
1993 1994
1998 1999 2000
2003
2005
Note: Questions concerning use of mammography differed slightly on the National Health Interview Survey across the years for which data are
shown. See Table 22 in Appendix A for more information.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Among women age 65 and over, the percentage
who had a mammogram within the preceding
2 years almost tripled from 23 percent in
1987 to 64 percent in 2005. While there was
a significant difference in 1987 between the
percentage of older non-Hispanic white
women (24 percent) and the percentage of
older non-Hispanic black women (14 percent)
who reported having had a mammogram, in
recent years, this difference has disappeared.
Older women who were poor were less likely
to have had a mammogram in the preceding 2
years than older women who were not poor.
In 2005, 52 percent of women age 65 and over
who lived in families with incomes less than
100 percent of the poverty threshold reported
having had a mammogram. Among older
women living in families with incomes 200
percent or more of the poverty threshold, 70
percent reported having had a mammogram.
Older women without a high school diploma
were less likely to have had a mammogram
than older women with a high school diploma.
In 2005, 51 percent of women age 65 and
over without a high school diploma reported
having had a mammogram in the preceding
2 years, compared with 64 percent of women
who had a high school diploma and 73 percent
of women who had some college education.
Data for this indicator's chart and bullets can
be found in Table 22 on page 107.
1900 1910
1920 1930 1940 1950 1960 1970
1980
1990 2000 2010
-------
INDICATOR 23
Diet Quality
A healthful diet can reduce some major risk factors for chronic diseases, such as obesity, Type 2 diabetes,
high blood pressure, and high blood cholesterol.25 The Healthy Eating Index-2005 (HEI-2005) is a
tool designed to measure compliance of diets with the key diet-quality recommendations of the 2005
Dietary Guidelines for Americans.26
Healthy Eating Index-2005 (HEI-2005) total scores for people age 55 and over,
by age group, 2001-2002
Score
100r
90
80
70
60
50
40
30
20
10
0
55-64
65 and over
65-74
75 and over
Note: Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005), which has 12 components. Each component represents a
different aspect of a healthful diet according to the 2005 Dietary Guidelines for Americans. A higher score for each component represents a
healthier diet. Dietary adequacy is addressed by Total Fruit; Whole Fruit (forms other than juice);Total Vegetables; Dark Green and Orange
Vegetables and Legumes (cooked dry beans and peas);Total Grains;Whole Grains; Milk (all milk products and soy beverages); Meat and Beans
(meat, poultry,fish,eggs,soybean products other than beverages, nuts,and seeds); and Oils (nonhydrogenated vegetable oils and oils in fish,
nuts, and seeds). For the remaining three components—Saturated Fat; Sodium; and Calories from Solid Fat, Alcohol, and Added Sugar—higher
scores reflect lower intakes. Diet quality,as opposed to quantity, is assessed by measuring intakes on a density,or per calorie, basis.Other health
measures related to the Dietary Guidelines are physical activity (see Indicator 24) and obesity (see Indicator 25).
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey,
2001-2002; U.S. Department of Agriculture, Center for Nutrition Policy and Promotion.
In 2001-2002, the total HEI-2005 score for
adults age 65 and over was 68 out of the
maximum 100 points. There were no significant
differences among the HEI-2005 total scores
for adults age 55-64, 65-74, or 75 and over.
HEI-2005 component scores for people age
65 and over indicate a need to increase intakes
of a number of food groups. Most in need of
improvement are intakes of whole grains; dark
green and orange vegetables and legumes; and
fat-free and lowfat milk and milk products.
Other food groups needing increased intake
are all types of vegetables and fruit. Oils,
including those in fish, nuts, and seeds, should
replace some solid fats. Decreased intakes
are needed especially of sodium, saturated fat,
and calories from foods and beverages with
solid fats, added sugar, and alcohol.
Data for this indicator's chart and bullets can
be found in Table 23 on page 108.
-------
INDICATOR 24
Physical Activity
Physical activity is beneficial for the health of people of all ages, including the 65 and overpopulation.
It can reduce the risk of certain chronic diseases, may relieve symptoms of depression, helps to maintain
independent living, and enhances overall quality of life.27'28 Research has shown that even among frail
and very old adults, mobility and functioning can be improved through physical activity.29
Percentage of people age 45 and over who reported engaging in regular
leisure time physical activity, by age group, 1997-2006
Percent
100
90
80
70
60
50
40
30
20
10
,45-64
65 and over
T 65-74
• 75-84
' 85 and over
0
1997-1998
I
I
I
J
1999-2000
2001-2002
2003-2004
2005-2006
Note: Data are based on 2-year averages. "Regular leisure time physical activity" is defined as "engaging in light-moderate leisure time physical
activity for greater than or equal to 30 minutes at a frequency greater than or equal to 5 times per week, or engaging in vigorous leisure time
physical activity for greater than or equal to 20 minutes at a frequency greater than or equal to 3 times per week."
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
In 2005-2006, 22 percent of people age 65
and over reported engaging in regular leisure
time physical activity. The percentage of older
people engaging in regular physical activity
was lower at older ages, ranging from 26
percent among people age 65-74 to 10 percent
among people age 85 and over. There was no
significant change in the percentage reporting
physical activity between 1997 and 2006.
Men age 65 and over are more likely than
women in the same age group to report engag-
ing in regular leisure time physical activity
(25 percent and 19 percent, respectively, in
2005-2006). Older non-Hispanic white peo-
ple report higher levels of physical activity
than non-Hispanic black people or Hispanics
(23 percent compared with 16 percent for
Hispanics and 14 percent for non-Hispanic
blacks in 2005-2006).
Other forms of physical activity also contribute
to overall health and fitness. Strength training
is recommended as part of a comprehensive
physical activity program among older adults
and may help to improve balance and decrease
risk of falls.30 Thirteen percent of older people
reported engaging in strengthening exercises
in 2005-2006.
Data for this indicator's chart and bullets can
be found in Tables 24a and 24b on page 109.
1900
1910
1920 1930
1940
1950 1960
1970
1980
1990 2000 2010
-------
INDICATOR 25
Obesity
Obesity and overweight have reached epidemic proportions in the United States. Similar to cigarette
smoking, obesity is a major cause of preventable disease and premature death.31 Both are associated
with increased risk of coronary heart disease; Type 2 diabetes; endometrial, colon, postmenopausal
breast, and other cancers; asthma and other respiratory problems; osteoarthritis; and disability.3233
Percentage of people age 65 and over who are obese, by sex and age group,
selected years 1988-2006
Percent Percent
100 r 100
90
80
70
60
50
40
30
20
10
0
Men
24
90
80
70
60
50
40
30
20
10
• 65-74 • 75 and over
Women
1988-
1994
1999- 2001- 2003- 2005-
2000 2002 2004 2006
1988-
1994
1999- 2001- 2003- 2005-
2000 2002 2004 2006
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.
As with other age groups, the percentage of
people age 65 and over who are obese has
increased since 1988-1994. In 2005-2006,
37 percent of noninstitutionalized women
age 65-74 and 24 percent of women age 75
and over were obese. This is an increase from
1988-1994, when 27 percent of women age
65-74 and 19 percent of women age 75 and
over were obese.
Older men follow similar trends; 24 percent of
men age 65-74 and 13 percent of men age 75
and over were obese in 1988-1994, compared
with 33 percent of men age 65-74 and 25
percent of men age 75 and over in 2005-2006.
Over the past 7 years, the trend has leveled
off, with no statistically significant change
in obesity for older men or women between
1999-2000 and 2005-2006.
Data for this indicator's chart and bullets can
be found in Table 25 on page 110.
1900
1910
1920
1930 1940
1950
1960 1970
1980
1990 2000 2010
-------
INDICATOR 26
Cigarette Smoking
Smoking has been linked to an increased likelihood of cancer, cardiovascular disease, chronic obstructive
lung diseases, and other debilitating health conditions. Among older people, the death rate for chronic
lower respiratory diseases (the fourth leading cause of death among people age 65 and over) increased
53 percent between 1981 and 2004. See "Indicator 15: Mortality." This increase reflects, in part, the
effects of cigarette smoking.34
Percentage of people age 65 and over who are current cigarette smokers, by
sex, selected years 1965-2007*
Percent
100
90
80
70
60
50
40
30
20
10
Men
1965
1974
1979
1983
1990
1995
2000
* The 2007 estimates are based on Early Release National Health Interview Survey data collected January-June 2007, using preliminary weights.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
The percentage of older Americans who
are current cigarette smokers declined
dramatically in the four decades between 1965
and 2005. Most of the decrease during this
period is the result of the declining prevalence
of cigarette smoking among men (from 29
percent in 1965 to 9 percent in 2005). For
the same period, the percentage of women
who smoke cigarettes has remained relatively
constant, increasing slightly from 10 percent
in 1965 before declining to 8 percent in 2005.
In 2006, however, the decline among older male
smokers appeared to have reversed, with the
percentage of current male smokers increasing
to 13 percent. This observed increase for men
in 2006 may be an anomaly as preliminary
data for January-June 2007 show a return to
the level in 2005 (9 percent). Among women
of the same age, levels of cigarette smoking
remained the same (8 percent in both 2006
and 2007).
A large percentage of men and women age
65 and over are former smokers. In 2006,
51 percent of older men previously smoked
cigarettes, while nearly 28 percent of women
age 65 and over were former smokers.
Data for this indicator's chart and bullets
can be found in Tables 26a and 26b on pages
111-112.
1900
1910
1920
1930 1940
1950 1960 1970 1980 1990 2000 2010
-------
INDICATOR 27
Air Quality
As people age, their bodies are less able to compensate for the effects of environmental hazards.
Air pollution can aggravate heart and lung disease, leading to increased medication use, more visits
to health care providers, admissions to emergency rooms and hospitals, and even death.35"39 An
important indicator for environmental health is the percentage of older adults living in areas that have
measured air pollutant concentrations above the Environmental Protection Agency's (EPA) established
standards. Ozone and particulate matter (PM) (especially smaller, fine particle pollution called
PM 2.5) have the greatest potential to affect the health of older adults.
Percentage of people age 65 and over living in counties with "poor air quality/'
2000-2006
Percent
100
90
80
70
60
50
40
30
20
10
Any standard
2000
2001
2002
2003
2004
2005
2006
Note: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards
(NAAQS).The term "any standard" refers to any NAAQSfor ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and
lead. Data for previous years have been computed using the new daily PM 2.5 standard of 35 micrograms/m3 to enable comparisons across
time.This results in percentages that are not comparable to previous publications.
Reference population: These data refer to the resident population.
Source: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau,
Population Projections, 2000-2006.
In 2006, 24 percent of people age 65 and over
lived in counties with poor air quality for ozone
compared with 31 percent in 2000. Since the
year 2000, ground level ozone pollution peaked
in 2002 when the United States experienced a
hot, dry summer climate that was particularly
conducive to the formation of ground-level
ozone.
A comparison of 2000 and 2006 shows a
reduction in PM 2.5. In 2000, 44 percent
of people age 65 and over lived in a county
where PM 2.5 concentrations were at times
above the EPA standards compared with 21
percent of people age 65 and over in 2006.
The percentage of people age 65 and over
living in counties that experienced poor air
quality for any air pollutant decreased from
55 percent in 2000 to 34 percent in 2006.
1900 1910
1920 1930
1940
1950 1960
1970
1980
1990
2000 2010
-------
INDICATOR 27
Air Quality continued
Air quality varies across the United States; thus, where people live can affect their health risk. Each
State monitors air quality and reports findings to the Environmental Protection Agency (EPA). In turn.
the EPA determines whether pollutant measurements meet the standards that have been set to protect
human health.
Counties with "poor air quality" for any standard in 2006
Note: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (N AAQS).
The term "any standard" refers to any N AAQS for ozone, paniculate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead.
Reference population: These data refer to the resident population.
Source: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, Population
Projections, 2000-2006.
In 2006, nearly 38 percent of the population
lived in a county where measured air pollutants
reached concentrations above EPA standards.
This percentage was fairly consistent across
all age groups, including people age 65 and
over.
Overall, approximately 113 million people
lived in counties where monitored air in
2006 was unhealthy at times because of high
levels of at least one of the six principal air
pollutants: ozone, particulate matter (PM),
nitrogen dioxide, sulfur dioxide, carbon
monoxide, and lead. The vast majority of
areas that experienced unhealthy air did so
because of one or both of two pollutants—
ozone and PM.
Data for this indicator's charts and bullets
can be found in Tables 27a and 27b on pages
112-114.
-------
INDICATOR 28
Use of Time
How individuals spend their time reflects their financial and personal situations, needs, or desires.
Time-use data show that as Americans get older, they spend more of their time in leisure activities.
Percentage of day that people age 55 and over spent doing selected activities
on an average day, by age group, 2006
Percent
100
90
80
70
60
50
40
30
20
10
0
Caring for and helping others
Sleeping
Grooming
Leisure activities
Work and work-related activities
Household activities
Purchasing goods and services
Eating and drinking
Other activities
55-64
65-74
75 and over
Note: "Other activities"includes activities such as educational activities;organizational,civic,and religious activities;and telephone
calls.Chart includes people whodid not work at all.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Bureau of Labor Statistics, American Time Use Survey.
In 2006, older Americans spent on average
more than one-quarter of their time in leisure
(6.5 hours per day). This proportion increased
with age: Americans age 75 and over spent 33
percent of their time in leisure compared with
23 percent for those age 55-64.
On an average day, people age 55-64 spent 16
percent of their time (almost 4 hours) working
or doing work-related activities compared
with 4 percent (less than one hour) for people
age 65-74 and 1 percent (less than 30 minutes)
for people age 75 and over.
-------
INDICATOR 28
Use of Time continued
Leisure activities are those done when free from duties such as working, household chores, or caring for
others. During these times, individuals have flexibility in choosing what to do.
Percentage of total leisure time that people age 55 and over spent doing selected
leisure activities on an average day, by age group, 2006
Percent
100r
90
80
70
60
50
40
30
20
10
0
Watching TV
Socializing and communicating
Reading
Relaxing and thinking
Participation in sports, exercise, and recreation
Other leisure activities (including related travel)
55-64
65-74
75 and over
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Bureau of Labor Statistics, American Time Use Survey.
Watching TV was the activity that occupied
the most leisure time—about one-half the
total—for Americans age 55 and over.
Americans age 75 and over spent a higher
percentage of their leisure time reading (14
percent versus 10 percent) and relaxing and
thinking (11 percent versus 7 percent) than
did Americans age 55-64.
The proportion of leisure time that
older Americans spent socializing and
communicating—such as visiting friends or
attending or hosting social events—declined
with age. For Americans age 55-64, 13
percent of leisure time was spent socializing
and communicating compared to 10 percent
for those age 75 and over.
Data for this indicator's charts and bullets
can be found in Tables 28a and 28b on page
115.
-------
-------
Health Care
Indicator 29:
Indicator 30:
Indicator 31:
Indicator 32:
Indicator 33:
Use of Health Care Services
Health Care Expenditures
Prescription Drugs
Sources of Health Insurance
Out-of-Pocket Health Care
Expenditures
Indicator 34: Sources of Payment for Health
Care Services
Indicator 35:
Indicator 36:
Indicator 37:
Indicator 38:
Veterans' Health Care
Nursing Home Utilization
Residential Services
Personal Assistance and Equipment
-------
INDICATOR 29
Use of Health Care Services
Most older Americans have health insurance through Medicare. Medicare covers a variety of services.
including inpatient hospital care, physician services, hospital outpatient care, home health care, skilled
nursing facility care, hospice services, and (beginning in January 2006) prescription drugs. Utilization
rates for many services change over time because of changes in physician practice patterns, medical
technology, Medicare payment policies, and patient demographics.
Medicare-covered hospital and skilled nursing facility stays per 1,000 Medicare
enrollees age 65 and over in fee-for-service, 1992-2005
Stays per 1,000
500
450
400
350
300
250
200
150
100
50
Hospital stays
Skilled nursing facility stays
I
I
I
J
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Note: Beginning in 1994, managed care enrollees were excluded from the denominator of all utilization rates because utilization data are not
available for them. Prior to 1994, managed care enrollees were included in the denominators; they comprised 7 percent or less of the
Medicare population.
Reference population: These data refer to Medicare enrollees in fee-for-service.
Source: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
Between 1992 and 1999, the hospitalization
rate increased from 306 hospital stays per
1,000 Medicare enrollees to 365 per 1,000.
The rate then decreased to 350 per 1,000
enrollees in 2005. The average length of a
hospital stay decreased from 8.4 days in 1992
to 5.7 days in 2005.
Skilled nursing facility stays increased
significantly from 28 per 1,000 Medicare
enrollees in 1992 to 79 per 1,000 in 2005.
Much of the increase occurred from 1992 to
1997.
1900
1910
1920
1930
1940
1950 1960 1970
1980
1990 2000 2010
-------
INDICATOR 29
Use of Health Care Services continued
Medicare-covered physician and home health care visits per 1,000 Medicare
enrollees age 65 and over in fee-for-service, 1992-2005
Visits per 1,000
15,000
12,500
10,000
7,500
5,000
2,500
0
Implementation of the
Balanced Budget Act
V
Physician visits
and consultations
Note: The vertical scale used in this chart is
not comparable to the vertical scale used in
the preceding chart on page48. Physician
visits and consultations and home health
care visits are much more common among
people age 65 and over than either
hospitalizations or skilled nursing facility
admissions.
Home health care visits
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
m m m m Data on physician visits and consultations are not available for 1997 and 1999.
Note: Physician visits and consultations include all settings, such as physician offices, hospitals,emergency rooms,and nursing homes. The
definition of physician visits and consultations changed beginning in 2003, resulting in a slightly lower rate. Beginning in 1994, managed care
enrollees were excluded from the denominator of all utilization rates because utilization data are not available for them. Prior to 1994, managed
care enrollees were included in the denominators; they comprised 7 percent or less of the Medicare population.
Reference population: These data refer to Medicare enrollees in fee-for-service.
Source: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
Between 1992 and 2005, the number of
physician visits and consultations increased.
There were 11,359 visits and consultations per
1,000 Medicare enrollees in 1992, compared
with 13,914 in 2005.
The number of home health care visits per
1,000 Medicare enrollees increased rapidly
from 3,822 in 1992 to 8,227 in 1997. Home
health care use increased during this period in
part because of an expansion in the coverage
criteria for the Medicare home health care
benefit.40 Home health care visits declined
after 1997 to 2,295 per 1,000 enrollees in
2001. The decline coincided with changes in
Medicare payment policies for home health
care resulting from implementation of the
Balanced Budget Act of 1997. The visit
rate increased thereafter to 2,770 per 1,000
enrollees in 2005.
Use of skilled nursing facility and home
health care increased markedly with age. In
2005, there were 30 skilled nursing facility
stays per 1,000 Medicare enrollees age 65-
74, compared with 228 per 1,000 enrollees
age 85 or over. Home health agencies made
1,333 visits per 1,000 enrollees age 65-74,
compared with 6,549 per 1,000 for those age
85 and over.
Data for this indicator's charts and bullets
can be found in Tables 29a and 29b on page
116.
1900
1910
1920 1930
1940
1950 1960 1970 1980 1990 2000 2010
-------
INDICATOR 30
Health Care Expenditures
Older Americans use more health care than any other age group. Health care costs are increasing rapidly
at the same time the Baby Boom generation is approaching retirement age.
Average annual health care costs for Medicare enrollees age 65 and over,
in 2004 dollars, by age group, 1992-2004
Dollars
24,000
22,000
20,000
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
.85 and over
.75-84
I
I
I
I
I
I
I
65-74
I
I
I
I
J
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Note: Data include both out-of-pocket costs and costs covered by insurance. Dollars are inflation adjusted to 2004 using the Consumer Price
Index (Series CPI-U-RS).
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
After adjusting for inflation, health care
costs increased significantly among older
Americans from 1992 to 2004. Average costs
were substantially higher at older ages.
Average health care costs varied by
demographic characteristics. Average costs
among non-Hispanic blacks were $14,989
in 2004, compared with $13,101 among
non-Hispanic whites and $11,962 among
Hispanics. Low income individuals incurred
higher health care costs; those with less than
$10,000 in income averaged $16,766 in health
care costs, whereas those with more than
$30,000 in income averaged only $10,676.
Costs also varied by health status. Individuals
with no chronic conditions incurred $4,718
in health care costs on average. Those with
five or more conditions incurred $20,334.
Average costs among residents of long-term
care facilities were $52,958, compared with
only $10,448 among community residents.
Access to health care is determined by a
variety of factors related to the cost, quality,
and availability of health care services. The
percentage of older Americans who reported
they delayed getting care because of cost
declined from 9.8 percent in 1992 to about
5 percent in 1997 and remained relatively
constant thereafter. The percentage who
reported difficulty obtaining care varied
between 2 percent and 3 percent.
1900
1910
1920
1930 1940
1950
1960 1970
1980
1990 2000 2010
-------
INDICATOR 30
Health Care Expenditures continued
Health care costs can be broken down into different types of goods and services. The amount of money
older Americans spend on health care and the type of health care that they receive provide an indication
of the health status and needs of older Americans in different age and income groups.
Major components of health care costs among Medicare enrollees age 65
and over, 1992 and 2004
Percent
100
90
80
70
60
50
40
30
20
10
0
Other
Prescription drugs
Home health care
Long-term care
facility
Physician/Outpatient
hospital
Inpatient hospital
1992
2004
Note: Data include both out-of-pocket costs and costs covered by insurance. "Other" includes short-term institutions, hospice services,
and dental care.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Hospital and physician services are the largest
components of health care costs. Long-term
care facilities accounted for 14 percent of total
costs in 2004. Prescription drugs accounted
for 15 percent of health care costs.
The mix of health care services changed
between 1992 and 2004. Inpatient hospital
care accounted for a lower share of costs in
2004 (25 percent compared to 32 percent
in 1992). Prescription drugs increased in
importance from 8 percent of costs in 1992
to 15 percent in 2004. "Other" costs (short
term institutions, hospice and dental care)
also increased as a percentage of all costs (4
percent to 8 percent).
The mix of services varied with age. The
biggest difference occurred for long-term care
facility services; average costs were $7,057
among people age 85 and over, compared
with just $431 among those age 65-74. Costs
of home health care and "other" services also
were higher at older ages. Costs of physician/
outpatient services and prescription drugs did
not show a strong pattern by age.
Data for this indicator's charts and bullets
can be found in Tables 30a, 30b, 30c, 30d, and
30e on pages 117-119.
1900
1910
1920 1930
1940
1950 1960
1970
1980
1990 2000 2010
-------
INDICATOR 31
Prescription Drugs
Prescription drug costs have increased rapidly in recent years, as more new drugs become available.
Lack of prescription drug coverage has created a financial hardship for many older Americans. Medicare
coverage of prescription drugs began in January 2006, including a low income subsidy for beneficiaries
with low incomes and assets.
Average annual prescription drug costs and sources of payment among noninsti-
tutionalized Medicare enrollees age 65 and over, 1992-2004
Dollars
2,200
2,000
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
Public programs
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Note: Dollars have been inflation adjusted to 2004 using the Consumer Price Index (Series CPI-U-RS). Reported costs have been adjusted by a
factor of 1.205 to account for underreporting of prescription drug use. Public programs include Medicare, Medicaid, Department of Veterans
Affairs, and other State and Federal programs.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Average prescription drug costs for older
Americans have increased rapidly in recent
years. Average costs per person were $2,107
in 2004.
Average out-of-pocket costs also increased,
though not as rapidly as total costs because
private and public insurance covered more
of the cost over time. Older Americans paid
60 percent of prescription drug costs out of
pocket in 1992, compared with 36 percent in
2004. Private insurance covered 38 percent
of prescription drug costs in 2004; public
programs covered 25 percent.
Costs varied significantly among individuals.
Approximately 8 percent of older Americans
incurred no prescription drug costs in 2004.
About 24 percent incurred $2,500 or more in
prescription drug costs that year.
1900
1910
1920 1930 1940
1950 1960
1970
1980
1990 2000 2010
-------
INDICATOR 31
Prescription Drugs continued
The purpose of this indicator is to provide a count of Medicare enrollees age 65 and over receiving
drug coverage through Part D or in plans of former employers subsidized by Part D. Under Medicare
Part D, beneficiaries may join a stand alone prescription drug plan or a Medicare Advantage plan that
provides prescription drug coverage in addition to other Medicare-covered services. In situations where
beneficiaries receive drug coverage from a former employer, the former employer may be eligible to
receive a retiree drug subsidy from Medicare to help cover the cost of the drug benefit.
Number of Medicare enrollees age 65 and over who enrolled in a Part D
prescription drug plan or were covered under the Retiree Drug Subsidy,
June 2006 and September 2007
Enrollment in millions
25 r
20
15
10
I No low income subsidy
I Low income subsidy
Part D plan Retiree Drug Subsidy
June 2006
Part D plan Retiree Drug Subsidy
September 2007
Reference population:These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Management Information Integrated Repository.
The number of Medicare beneficiaries age
65 and over enrolled in Part D prescription
drug plans increased from 18.2 million in
June 2006 to 19.7 million in September
2007. In September 2007, two-thirds of
enrollees were in stand-alone plans and one-
third were in Medicare Advantage plans.
In addition, approximately 6.5 million bene-
ficiaries were covered by the Retiree Drug
Subsidy in both years. Beneficiaries who were
not in Part D plans and not covered by the
Retiree Drug Subsidy either had drug coverage
through another source (e.g., Tricare, Federal
Employees Health Benefits plan, Department
of Veterans Affairs, or current employer) or
did not have drug coverage.
In September 2007, 5.9 million Part D
enrollees were receiving low income sub-
sidies. Many of these beneficiaries had drug
coverage through the Medicaid program prior
to enrollment in Part D.
Chronic conditions are associated with
high prescription drug costs. In 2004, older
Americans with no chronic conditions incurred
average prescription drug costs of $800. Those
with five or more chronic conditions incurred
$3,862 in prescription drug costs on average.
Data for this indicator's charts and bullets
can be found in Tables 3 la, 31 b, 31 c, and 3 Id
on pages 119-120.
1900
1910
1920 1930
1940
1950 1960
1970
1980
1990 2000 2010
-------
INDICATOR 32
Sources of Health Insurance
Nearly all older Americans have Medicare as their primary source of health insurance coverage. Medicare
covers mostly acute care services and requires beneficiaries to pay part of the cost, leaving about one-
half of health spending to be covered by other sources. Many beneficiaries have supplemental insurance
to fill these gaps and pay for services not covered by Medicare. Since January 2006, beneficiaries have
had the option of receiving prescription drug coverage through stand-alone prescription drug plans or
through some Medicare Advantage health plans.
Percentage of noninstitutionalized Medicare enrollees age 65 and over with
supplemental health insurance, by type of insurance, 1991-2005
Percent
100|
90
so
70
50
50
40
30
20
10
_ Private (Medigap)*
Private (employer
or union sponsored)
THMO
o
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
* Includes people with private supplement of unknown sponsorship.
Note: HMO health plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PRO), and private fee-for-service
plans (PFFS). Not all types of plans were available in all years. Since 2003 these types of plans have been known collectively as Medicare
Advantage. Estimates are based on enrollees' insurance status in the fall of each year. Categories are not mutually exclusive (i.e., individuals
may have more than one supplemental policy). Chart excludes enrollees whose primary insurance is not Medicare (approximately 1 to 2
percent of enrollees). Medicaid coverage was determined from both survey responses and Medicare administrative records; this is a change in
methodology from that used in Older Americans Update 2006 and produces different estimates for "Medicaid" and "No supplement"
categories.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Most Medicare enrollees have a private insur-
ance supplement, approximately equally split
between employer sponsored and Medigap
policies. The percentage with Medicaid cover-
age has increased slightly over the last several
years to about 12 percent in 2005. Enrollment
in Medicare HMOs and similar health plans,
which are usually equivalent to Medicare
supplements because they offer extra benefits,
varied between 6 percent and 21 percent.
About 12 percent of Medicare enrollees report
having no health insurance supplement.
Enrollment in HMOs and similar health plans
increased rapidly throughout the 1990s, then
decreased beginning in 2000 as many HMOs
withdrew from the Medicare program. The
percent with Medigap policies decreased in
the late 1990s as HMO enrollment increased.
There was a slight increase in the percentage
of Medicare enrollees without a supplement
in 2002.
Data for this indicator's chart and bullets
can be found in Tables 32a and 32b on pages
121-122.
1900
1910
1920
1930 1940
1950
1960 1970
1980
1990 2000 2010
-------
INDICATOR 33
Out-of-Pocket Health Care Expenditures
Large out-of-pocket expenditures for health care service use have been shown to encumber access to
care, affect health status and quality of life, and leave insufficient resources for other necessities.41'42
The percentage of household income that is allocated to health care expenditures is a measure of health
care expense burden placed on older people.
Out-of-pocket health care expenditures as a percentage of household income,
among people age 65 and over, by age and income category, 1977 and 2004
Percent
100r
90
80
70
60
50
40
30
20
10
Poor/Near poor
income category
29
29
Percent
100
90
so
70
60
50
40
30
20
10
1977
2004
Other income
category
8
o1 o
65 and over 65-74 75-84 85 and over 65 and over 65-74 75-84 85 and over
Note: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Including expenditures for out-of-pocket
premiums in the estimates of out-of-pocket spending would increase the percentage of household income spent on health care in all years. People
are classified into the "poor/near poor" income category if their household income is below 125 percent of the poverty level; otherwise, people are
classified into the"other" income category. For people with no out-of-pocket expenditures the ratio of out-of pocket spending to income was set to
zero. For additional details on how the ratio of out-of-pocket spending to income and the poverty level were calculated, see Table 33b in Appendix A.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.
The percentage of people age 65 and over
with out-of-pocket spending for health care
services increased between 1977 and 2004 (83
percent to 96 percent, respectively).
From 1977 to 2004, the percentage of
household income that people age 65 and
over allocated to out-of-pocket spending for
health care services increased among those
in the poor/near poor income category (from
12 percent to 29 percent). Increases were also
observed for those in poor or fair health, most
notably among those age 85 and over (from 9
percent to 18 percent).
In 2004, as in the 4 previous years, over one-
half of out-of-pocket health care spending by
people age 65 and over was used to purchase
prescription drugs (from 54 percent in 2000 to
61 percent in 2004).
In 2004, people age 85 and over were less
likely than people age 65-74 to spend out-
of-pocket dollars on dental services or office-
based medical provider visits but more likely
to spend out-of-pocket dollars on other health
care (e.g., home health care and eyeglasses).
Data for this indicator's chart and bullets can
be found in Tables 33a, 33b, and 33c on pages
122-124.
1900
1910
1920
1930
1940
1950 1950 1970
1980
1990 2000 2010
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INDICATOR 34
Sources of Payment for Health Care Services
Medicare covers about one-half of the health care costs of Medicare enrollees age 65 and over.
Medicare's payments are focused on acute care services such as hospitals and physicians. Nursing home
care, prescription drugs, and dental care have been primarily financed out-of-pocket or by other payers.
Medicare coverage of prescription drugs began in January 2006, including a low income subsidy.
Sources of payment for health care services for Medicare enrollees age
65 and over, by type of service, 2004
$183 $3,217 $380 $569 $3,427 $1,137 $1,987 $309
Average
cost per
$1,842 $13,052 enrol lee
100
90
80
70
- 60
D
j
u 50
40
30
20
10
0
Hospice Inpatient Home Short- Physician/ Out- Prescription Dental Long-term All
hospital health term Medical patient drugs care facility
care institution hospital
Note: "Other" refers to private insurance, Department of Veterans Affairs, and other public programs.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Other
Out-of-
pocket
Medicaid
Medicare paid for slightly more than one-
half (53 percent) of the health care costs of
Medicare enrollees age 65 and over in 2004.
Medicare finances most of their hospital and
physician costs, as well as a majority of short
term institutional, home health, and hospice
costs.
Medicaid covered 9 percent of health care
costs of Medicare enrollees age 65 and over,
and other payers (primarily private insurers)
covered another 19 percent. Medicare enroll-
ees age 65 and over paid 19 percent of their
health care costs out-of-pocket, not including
insurance premiums.
In 2004, 48 percent of long-term care facility
costs for Medicare enrollees age 65 and over
were covered by Medicaid; another 45 percent
of these costs were paid out-of-pocket. Fifty-
five percent of prescription drug costs were
covered by third party payers other than
Medicare and Medicaid, consisting mostly
of private insurers. Thirty-two percent of
prescription drug costs were paid out-of-
pocket. Seventy-six percent of dental care
received by older Americans was paid out-of-
pocket.
Sources of payment for health care vary by
income. Lower income individuals rely heav-
ily on Medicaid; those with higher incomes
rely more on private insurance. Lower income
individuals pay a lower percent of health care
costs out-of-pocket, but have a higher average
cost for services than individuals with higher
incomes.
Data for this indicator's chart and bullets can
be found in Tables 34a and 34b on page 125.
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INDICATOR 35
Veterans' Health Care
The number of veterans age 65 and over who receive health care from the Veterans Health
Administration (VHA) within the Department of Veterans Affairs has been steadily increasing. This
increase may be because VHA fills important gaps in older veterans' health care needs not currently
covered or fully covered by Medicare, such as mental health services, long-term care (nursing home
care and community-based care), and specialized services for the disabled.
Total number of veterans age 65 and over who are enrolled in or receiving care
from the Veterans Health Administration, 1990-2006
Millions
12
10
Veteran population
age 65 and over
VA health care
reform begins
V
I
VA health care
enrollment begins
V
VA patients
age 65 and over
V
VA enrollees
age 65 and over
V
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Note: Department of Veterans Affairs (VA) enrollees are veterans who have signed up to receive health care from the Veterans Health Administra-
tion (VHA). VA patients are veterans who have received care each year through VHA. Starting with 1999 data, the methods used to calculate VA
patients differ from what was used in Older Americans 2004 and Older Americans Update 2006. Veterans who received care but were not enrolled in
VA are now included in patient counts. VHA Vital Status files from the Social Security Administration (SSA) are now used to ascertain veteran
deaths.
Reference population: These data refer to the total veteran population, VHA enrollment population, and VHA patient population.
Source: Department of Veterans Affairs, Veteran Population 2004 Version 1.0; Fiscal 2006 Year-end Office of the Assistant Deputy Under Secretary
for Health for Policy and Planning Enrollment file linked with August 2007 VHA Vital Status data (including data from VHA.VA, Medicare, and SSA).
In 2006, approximately 2.4 million veterans
age 65 and over received health care from
VHA. An additional 1.1 million older veterans
were enrolled to receive health care from VHA
but did not use its services in 2006.
Reforms and initiatives implemented by VA
since 1996 have led to an increased demand
for VHA services among veterans despite the
short-term decline in the numbers of older
veterans (see "Indicator 6: Older Veterans").
Some of the changes include opening the
system to all veterans (1996), implementing
enrollment for VHA health care (1999), and
enhancing availability of outpatient and
community based care.
An increasing number of older veterans
are turning to VHA for their health care
needs despite their potential eligibility for
other sources of health care, most notably
prescription drug coverage through Medicare.
VHA estimates that 94 percent of its enrollees
age 65 and over are covered by Medicare
Part A, 74 percent by Medicare Part B, 51
percent by Medigap, 13 percent by Medicaid,
20 percent by private insurance (excluding
Medigap), and 10 percent by TRICARE for
Life. About 4 percent have no other public or
private coverage.43
Data for this indicator's chart and bullets can
be found in Table 35 on page 126.
\_
1900 1910
1920 1930 1940 1950 1960 1970
1980 1990 2000 2010
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INDICATOR 36
Nursing Home Utilization
Residence in a nursing home is an alternative to long-term care provided in one's home or in other
community settings. Recent declines in rates of nursing home residence may reflect broader changes in
the health care system affecting older Americans. Other forms of residential care and services, such as
assisted living and home health care, have become more prevalent as rates of nursing home admissions
have declined.
Rate of nursing home residence among people age 65 and over, by age group,
selected years 1985-2004
Per 1,000
250 i-
225
200
175
150
125
100
75
50
25
r 85 and over
,65-74
1985
1995
1997
1999
2004
Note: Rates are calculated using estimates of the civilian population of the United States including institutionalized people. Population data
are from unpublished tabulations provided by the U.S. Census Bureau. The 2004 population estimates are postcensal estimates as of July 1,2004,
based on Census 2000. For more information about the 2004 population estimates,see Kozak, DeFrances, and Hall.44 Rates are age adjusted
to the year 2000 population standard using the following three age groups: 65-74 years, 75-84 years, and 85 years and over. Residents are
people on the roster of the nursing home as of the night before the survey. Residents for whom beds are maintained even though they
may be away on overnight leave or in a hospital are included. People residing in personal care or domiciliary care homes are excluded.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Nursing Home Survey.
In 2004, 9 people per 1,000 age 65-74 resided
in nursing homes, compared with 36 people
per 1,000 age 75-84 and 139 people per 1,000
age 85 and over.
The total rate of nursing home residence among
the older population declined between 1985
and 2004. In 1985, the age adjusted nursing
home residence rate was 54 people per 1,000
age 65 and over. By 2004 this rate had declined
to 35 people per 1,000. Among people age 65-
74, rates declined by 24 percent, compared
with a 37 percent decline among people age
75-84 and age 85 and over.
Despite the decline in rates of nursing home
residence, the number of nursing home
residents age 65 and over had been increasing
until recently because of the rapid growth
of the older population. Between 1985 and
1999, the number of current nursing home
residents age 65 and over increased from 1.3
million to 1.5 million but then declined to 1.3
million in 2004. In 2004, almost three-fourths
(980,000) of older nursing home residents
were women.
1900 1910
1920 1930 1940 1950 1960 1970
1980 1990 2000 2010
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INDICATOR 36
Nursing Home Utilization continued
Percentage of nursing home residents age 65 and over, by amount of
assistance with activities of daily living (ADLs), 2004
Percent
100
90
80
70
60
50
40
30
20
10
Total dependence
Some assistance
Bathing
Dressing
Eating
Transferring
Toileting
Note: Residents are people on the roster of the nursing home as of the night before the survey. Residents for whom beds are maintained even
though they may be away on overnight leave or in a hospital are included. People residing in personal care or domiciliary care homes are excluded.
Excludes residents for whom activities did not occur and unknowns. ADL self-performance is ascertained for residents' performance over all shifts
during the last 7 days, not including setup of the activity. No assistance includes people who were coded as independent (no help or oversight
-or- help/oversight provided only 1 or 2 times during last 7 days) or receiving supervision (oversight, encouragement or cueing provided 3 or
more times during last 7 days). Some assistance includes people who were coded as limited assistance (resident highly involved in activity;
received physical help in guided maneuvering of limbs or other nonweight bearing assistance 3 or more times -or- more help provided only 1 or 2
times during last 7 days) or extensive assistance (while resident performed part of activity, over last 7 day period, help of following type(s) provided
3 or more times: a) weight-bearing support and/or b) full staff performance during part (but not all) of last 7 days).Total dependence includes
people who were coded as full staff performance of activity during entire 7 days.
Reference population:These data refer to the population residing in nursing homes.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Nursing Home Survey.
In 2004, the majority of nursing home residents
age 65 and over received assistance with at least
one activity of daily living (ADL). Levels of
assistance provided for individual ADLs were
high, from 94 percent for bathing to 73 percent
for transferring. The only ADL for which the
majority of residents received no assistance (65
percent) was eating.
Among the nursing home population, women
were more likely than men to require full
assistance with daily activities. The percentage of
women who were totally dependent in any one of
the five activities was higher than that for men.
Conversely, men were more likely to receive no
assistance with daily activities.
Older white nursing home residents were less
likely than black residents or residents of other
races to be dependent in daily activities. For
example, nearly one-half of all black and other
race residents were dependent in bathing, 46
percent for both, while 37 percent of white
residents required total assistance. White
residents were more likely to receive some
intermediate level of assistance.
Data for this indicator's charts and bullets can
be found in Tables 36a, 36b, and 36c on pages
127-129.
-------
INDICATORS?
Residential Services
Some older Americans living in the community have access to various services through their place of
residence. Such services may include meal preparation, laundry and cleaning services, and help with
medications. Availability of such services through the place of residence may help older Americans
maintain their independence and avoid institutionalization.
Percentage of Medicare enrollees age 65 and over residing in selected
residential settings, by age group, 2005
Percent
100
90
80
70
60
50
40
30
20
10
Long-term care
facility
Community housing
with services
Traditional
community
65 and over
65-74
75-84
85 and over
Note: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior
citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and
other similar situations, AND who reported they had access to one or more of the following services through their place of residence: meal
preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents were asked about access to these
services but not whether they actually used the services. A residence (or unit) is considered a long-term care facility if it is certified by Medi-
care or Medicaid; has 3 or more beds and is licensed as a nursing home or other long-term care facility and provides at least one personal
care service; or provides 24-hour, 7-day-a-week supervision by a non-family, paid caregiver.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
In 2005, 2 percent of the Medicare population
aged 65 and over resided in community
housing with at least one service available.
Approximately 5 percent resided in long-
term care facilities. The percentage of people
residing in community housing with services
and in long-term care facilities was higher for
the older age groups; among individuals age
85 and over, 7 percent resided in community
housing with services, and 17 percent resided
in long-term care facilities. Among individuals
age 65-74, 98 percent resided in traditional
community settings.
Among residents of community housing with
services, 86 percent reported access to meal
preparation services, 82 percent reported
access to housekeeping/cleaning services, 70
percent reported access to laundry services,
and 45 percent reported access to help
with medications. These numbers reflect
percentages reporting availability of specific
services, but not necessarily the number that
actually used these services.
More than one-half (54 percent) of residents
in community housing with services reported
that there were separate charges for at least
some services.
-------
INDICATORS?
Residential Services continued
Percentage of Medicare enrollees age 65 and over with functional limitations,
by residential setting, 2005
Percent
100
90
80
70
60
50
40
30
20
10
3 or more ADL limitations
1-2 ADL limitations
IADL limitations only
No functional limitations
Traditional community
Community housing
with services
Long-term care
facility
Note: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior
citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and
other similar situations, AND who reported they had access to one or more of the following services through their place of residence: meal
preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents were asked about access to these
services but not whether they actually used the services. A residence (or unit) is considered a long-term care facility if it is certified by Medi-
care or Medicaid; has 3 or more beds and is licensed as a nursing home or other long-term care facility and provides at least one personal care
service; or provides 24-hour 7-day-a-week supervision by a non-family, paid caregiver. Activities of Daily Living (ADLs) limitations refer to diffi-
culty performing (or inability to perform, for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of
chairs, walking, or using the toilet. Instrumental Activities of Daily Living (I ADLs) limitations refer to difficulty performing (or inability to per
form, for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shop-
ping, or managing money. Long-term care facility residents with no limitations may include individuals with limitations in certain lADLs: doing
light or heavy housework or meal preparation. These questions were not asked of facility residents.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
People living in community housing with
services had more functional limitations than
traditional community residents, but not as
many as those living in long term care facilities.
Forty-six percent of individuals living in
community housing with services had at least
one activity of daily living (ADL) limitation
compared with 26 percent of traditional
community residents. Among long-term care
facility residents, 82 percent had at least one
ADL limitation. Forty percent of individuals
living in community housing with services
had no ADL or instrumental activities of daily
living (IADL) limitations.
The availability of personal services in
residential settings may explain some of the
observed decline in nursing home use (see
"Indicator 36: Nursing Home Utilization").
Residents of community housing with services
tended to have slightly lower incomes than
traditional community residents, but higher
incomes than long-term care facility residents.
Twenty-two percent of residents of community
housing with services had incomes of $10,000
or less in 2005, compared with 15 percent
of traditional community residents and 40
percent of long-term care facility residents.
Over one-half (52 percent) of people living
in community housing with services reported
they could continue living there if they needed
substantial care.
Data for this indicator's charts and bullets can
be found in Tables 37a, 37b, 37c, 37d, and 37e
on pages 130-132.
-------
INDICATOR 38
Personal Assistance and Equipment
Possible reasons for the decline in nursing home rates (see "Indicator 36: Nursing Home Utilization")
include improvements in the health and functioning of the older population, changes in household living
arrangements (e.g., the move toward assisted living and other residential care alternatives), and greater
use of personal assistance and/or special equipment that help older people living in the community
maintain their independence.
Distribution of noninstitutionalized Medicare enrollees age 65 and over who
have limitations in activities of daily living (ADLs), by type of
assistance, selected years 1992-2005
Percent
100
None
Personal assistance
and equipment
Personal assistance
only
Equipment only
1992 1997 2001 2005
Note: The Medicare Current Beneficiary Survey has replaced the National Long Term Care Survey as the data source for this indicator. Conse-
quently, the measurement of personal assistance and equipment has changed from previous editions of Older Americans. ADL limitations refer
to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out
of chairs, walking, or using the toilet. Respondents who report difficulty with an activity are subsequently asked about receiving help or
supervision from another person with the activity and about using special equipment or aids. In this chart, personal assistance does not
include supervision.
Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more ADLs.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Between 1992 and 2005, the age adjusted
proportion of people age 65 and over who had
difficulty with one or more ADLs and who did
not receive personal assistance or use special
equipment with these activities decreased
from 42 percent to 35 percent. More people
are using equipment only—the percentage
increased from 28 percent to 36 percent.
The percentage of people who used personal
assistance only decreased from 9 percent to 7
percent.
In 2005, nearly two-thirds (65 percent) of
people who had difficulty with one or more
ADLs received personal assistance or used
special equipment: 7 percent received personal
assistance only, 36 percent used equipment
only, and 22 percent used both personal
assistance and equipment.
1900
1910
1920 1930
1940
1950 1960
1970
1980 1990 2000 2010
-------
INDICATOR 38
Personal Assistance and Equipment continued
Percentage of noninstitutionalized Medicare enrollees age 65 and over who
have limitations in instrumental activities of daily living (lADLs) and who
receive personal assistance, by age group, selected years 1992-2005
Percent
100
90
80
70
60
SO
40
30
20
10
65-74
75-84
85 and over
69
63
59
1992
1997
2001
2005
Note: The Medicare Current Beneficiary Survey has replaced the National Long Term Care Survey as the data source for this indicator. Conse-
quently, the measurement of personal assistance has changed from previous editions of Older Americans. IADL limitations refer to difficulty
performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy
housework, meal preparation, shopping, or managing money. Respondents who report difficulty with an activity are subsequently asked
about receiving help from another person with the activity. In this chart, personal assistance does not include supervision or special equip-
ment.
Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more lADLs.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
In 2005, more than three-fifths of people age
65 and over who had difficulty with one or
more lADLs received personal assistance.
The percentage of people receiving personal
assistance was higher for people age 85 and
over (74 percent) than it was for people age
75-84 (67 percent) or people age 65-74 (63
percent).
There was no significant change between
1992 and 2005 in the percentage of people (in
any age group) who had difficulty with one
or more lADLs and who received personal
assistance. Men and women were equally
likely to receive assistance.
Data for this indicator's charts and bullets
can be found in Tables 38a and 38b on page
132.
1900
1910
1920 1930 1940
1950 1960
1970
1980
1990 2000 2010
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SPECIAL FEATURE
Literacy
Literacy is an important skill that enables people to communicate and function in society.45 Everyday
tasks such as reading a newspaper, balancing a checkbook, or applying for a job require an adequate
level of literacy.
Percentage of people age 65 and over in each literacy performance level, by
literacy component, 1992 and 2003
Percent
100
90
80
70
60
50
40
30
20
10
Proficient: Read complex
material and draw
sophisticated inferences
Intermediate: Read
moderately complex
text and draw simple
inferences
Basic: Read simple
words in common text
Below Basic: No more
than the most simple and
concrete reading skills
1992
2003
Prose
1992 2003
Document
1992 2003
Quantitative
Note: Literacy is measured using three different components: prose literacy is the ability to search,comprehend,and use information from
continuous texts (e.g., reading a newspaper); document literacy is the ability to search, comprehend,and use information from noncontinuous
text (e.g., bus schedules); and quantitative literacy is the ability to identify and perform computations using numbers embedded in printed
materials (e.g., calculating numbers in tax forms).
Reference population: These data refer to people residing in households or prisons.
Source: U.S. Department of Education, National Center for Education Statistics, National Assessment of Adult Literacy.
The majority of older Americans face literacy
challenges. In 2003, 60 percent of people age
65 and over had below basic or basic document
and prose literacy, and 71 percent had below
basic or basic quantitative literacy. Only 3
percent to 5 percent of older Americans had
proficient literacy in any component.
Between 1992 and 2003, the percentage of
older Americans that had below basic prose,
document, and quantitative literacy decreased
significantly, from 33 percent to 23 percent
for prose, from 38 percent to 27 percent for
document, and from 49 percent to 34 percent
for quantitative.
1900 1910
1920 1930
1940
1950 1960 1970 1980 1990 2000 2010
-------
SPECIAL FEATURE
Health Literacy
Health literacy is the degree to which people have the capacity to obtain, process, and understand
basic health information and services needed to make appropriate health decisions.46"48 Adhering to
prescription instructions, filling out a patient information form, or giving informed consent are specific
tasks that require more than just an adequate level of literacy—they require an adequate level of health
literacy.
Percentage of people age 50 and over in each health literacy performance level,
by age group, 2003
Percent
100
90
80
70
60
SO
40
30
20
10
0
Proficient: Find the
definition of a medical
term in a complex health
document
Intermediate:
Determine a healthy
weight range using a
body mass index chart
Basic: Understand a
one page article about
a health condition
Below Basic:
Circle the date of a
medical appointment
on a hospital
appointment slip
50-64
65-74
75 and over
Note: Health literacy is the ability to locate and understand health-related information and services and requires skills represented in the
three general components defined on the previous page—prose,document,and quantitative literacy. Tasks used to measure health literacy
were organized around three domains of health and health care information and services—clinical, prevention, and navigation of the health
care system—and mapped to the performance levels (proficient, intermediate, basic, and below basic) based on their level of difficulty.
Reference population: These data refer to people residing in households or prisons.
Source: U.S. Department of Education, National Center for Education Statistics, National Assessment of Adult Literacy.
Older adults are proportionately more likely
to have below basic health literacy than
any other age group. Almost two-fifths (39
percent) of people age 75 and over have a
health literacy level of below basic compared
with 23 percent of people age 65-74 and 13
percent of people age 50-64.
Current levels of health literacy among
people age 50-64 suggest fewer people 65 and
over will have below basic levels of health
literacy. This is important because poor health
literacy is associated with cognitive decline
among those age 80 and over, a group that is
increasing in size.49
Data for this Special Feature 's charts and
bullets can be found in Special Feature Tables
on page 133.
-------
-------
Data Needs
problem, new legal requirements for reporting
abuse, and advances in questionnaire design.
In Older Americans 2004, the Federal Inter-
agency Forum on Aging-Related Statistics
(Forum) identified 12 areas where more data
were needed to support research and policy
efforts. These areas included substantive topics
as well as improved data collection methods and
reporting. In this report, the Forum decided to
focus the "Data Needs" section more narrowly
on topics that could become new indicators, or
improve existing indicators, if more or better data
were available. The following six topics have
been identified by the Forum as priority areas for
indicator development: caregiving, elder abuse,
functional limitations and disability, mental
health, pension measures, and residential care.
Either more national data are needed on the topic
or there has been difficulty reaching consensus
on relevant definitions and measurements.
Caregiving
There is growing recognition that family
caregivers of older people with disabilities and/
or moderate to severe cognitive impairment
are under considerable strain. It is primarily
informal (unpaid) family caregivers who pro-
vide the assistance that enables the great
majority of chronically disabled older people to
continue to live in the community rather than in
specialized care facilities. It has been estimated
that the annual economic value of informal
eldercare exceeds national spending on formal
(paid) care.50 Disabled older people at risk of
nursing home placement typically require at
least 50 hours per week of personal assistance
with functional activities.51 Data are needed so
that it will be possible to monitor the amount
and sources of informal caregiving.
Elder Abuse
In 1998, the Institute of Medicine at the National
Academies reported a "paucity of research"
on elder abuse and neglect, with most prior
studies lacking empirical evidence.52 There are
no reliable national estimates of elder abuse,
nor are the risk factors clearly understood. The
need for a national study of elder abuse and
neglect is supported by the growing number of
older people, increasing public awareness of the
Functional Limitations and
Disability
Information on trends in functioning and
disability is critical for monitoring the health and
well-being of the older population. However,
the concept of disability encompasses many
different dimensions of health and functioning
and complex interactions with the environment.
Furthermore, specific definitions of disability
are used by some government agencies to
determine eligibility for benefits. As a result,
disability is often measured in different ways
across surveys and censuses, and this has led
to disparate estimates of the prevalence of
disability. To the extent possible, population
based surveys designed to broadly measure
disability in the older population should use a
common conceptual framework. Federal agenc-
ies continue to work together to find ways to
compare existing measures of functioning and
disability across different surveys and to devel-
op new ways to measure this complicated, multi-
dimensional concept. Longitudinal data that can
be used to monitor changes in patterns and in
transitions in functional status are also needed.
Mental Health
Research that has helped differentiate mental
disorders from "normal" aging has been one
of the more important achievements of recent
decades in the field of geriatric health. Depres-
sion, anxiety, schizophrenia, and alcohol and
drug misuse and abuse, if untreated, can be
severely impairing, even fatal. There is also a
need for more data and better measurement of the
incidence and prevalence of Alzheimer's disease
and other causes of dementia. Despite interest
and increased efforts to track all of these disorders
among older adults, obtaining national estimates
has proven to be difficult. Research is underway
to address the challenges in developing indica-
tors of cognitive and mental health.
Pension Measures
As pension plans shift away from defined-benefit
pensions and annuities to defined-contribution
plans, irregular payments will become more
important to older people's income. In the
future, improved data measuring withdrawals
-------
of money from these retirement investment
accounts (deferred earned income in IRAs and
40 Iks) will lead to improved measurement of
income and poverty for people age 65 and over.
Residential Care
A general shift in State Medicaid long-term care
policy and independent growth in private-pay
residential care has led to an increasing set of
alternatives to home care and traditional skilled
nursing facilities. Residential care outside of
the traditional nursing home is provided in
diverse settings (e.g., assisted living facilities,
board and care homes, personal care homes,
and continuing-care retirement communities).
A common characteristic is that these places
provide both housing and supportive services.
Supportive services typically include protective
oversight and help with instrumental activities
of daily living (lADLs) such as transportation,
meal preparation, and taking medications, and
more basic activities of daily living (ADLs)
such as eating, dressing and bathing. Despite the
growing role of residential care, we have little
national data on the number and characteristics of
facilities and the people living in these settings.
Federal agencies associated with the Federal
Interagency Forum on Aging-Related Statistics
are therefore working together to design a new
survey to obtain these estimates.
-------
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-------
Appendix A: Detailed Tables
-------
INDICATOR 1
Number of Older Americans
Table la. Number of people age 65 and over and 85 and over,
selected years 1900-2006 and projected 2010-2050
Year
Estimates
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2005
2006
Projections
2010
2020
2030
2040
2050
65 and over
In
3.1
3.9
4.9
6.6
9.0
12.3
16.2
20.1
25.5
31.2
35.0
36.8
37.3
40.2
54.6
71.5
80.0
86.7
85 and over
millions
0.1
0.2
0.2
0.3
0.4
0.6
0.9
1.5
2.2
3.1
4.2
5.1
5.3
6.1
7.3
9.6
15.4
20.9
Reference population: These data refer to the resident population.
Source: U.S. Census Bureau, 1900 to 1940,1970, and 1980, U.S. Census Bureau, 1983, Table 42; 1950, U.S. Census Bureau, 1953,
Table 38; 1960, U.S. Census Bureau, 1964, Table 155; 1990, U.S. Census Bureau, 1991,1990 Summary Table File 1; 2000, U.S. Census
Bureau, 2001, Census 2000 Summary File 1; Table 1: Estimates of the population by selected age groups for the United States and
for Puerto Rico: July 1, 2006 (SC-EST2006-1); 2010 to 2050, International Programs Center, International Data Base, 2007.
Table 1 b. Percentage of the population age 65 and over and
85 and over, selected years 1900-2006 and projected 2010-2050
Year
Estimates
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2005
2006
Projections
2010
2020
2030
2040
2050
65 and over
4.1
4.3
4.7
5.4
6.8
8.1
9.0
9.9
11.3
12.6
12.4
12.4
12.4
13.0
16.3
19.6
20.4
20.6
85 and over
Percent
0.2
0.2
0.2
0.2
0.3
0.4
0.5
0.7
1.0
1.2
1.5
1.7
1.8
2.0
2.2
2.6
3.9
5.0
Reference population: These data refer to the resident population.
Source: U.S. Census Bureau, 1900 to 1940,1970, and 1980, U.S. Census Bureau, 1983, Table 42; 1950, U.S. Census Bureau, 1953,
Table 38; 1960, U.S. Census Bureau, 1964, Table 155; 1990, U.S. Census Bureau, 1991,1990 Summary Table File 1; 2000, U.S. Census
Bureau, 2001, Census 2000 Summary File 1; Table 1: Estimates of the population by selected age groups for the United States and
for Puerto Rico: July 1, 2006 (SC-EST2006-1); 2010 to 2050, International Programs Center, International Data Base, 2007.
-------
INDICATOR 1
Number of Older Americans continued
Table 1 c. Population of countries or areas with at least 10 percent of their
population age 65 and over, 2006
Population (number in thousands)
Country or Area
Japan
Italy
Germany
Greece
Spain
Sweden
Belgium
Bulgaria
Estonia
Portugal
Austria
Croatia
Georgia
Latvia
Ukraine
Finland
France
United Kingdom
Slovenia
Switzerland
Lithuania
Denmark
Hungary
Serbia
Belarus
Norway
Romania
Luxembourg
Czech Republic
Bosnia and Herzegovina
Netherlands
Russia
Malta
Montenegro
Canada
Poland
Uruguay
Australia
Hong Kong S.A.R.
Puerto Rico
United States
Slovakia
New Zealand
Iceland
Cyprus
Ireland
Virgin Islands (U.S.)
Armenia
Macedonia
Moldova
Argentina
Cuba
Taiwan
Total
127,515
58,1 34
82,422
10,688
40,398
9,017
10,379
7,385
1,324
10,606
8,193
4,495
4,661
2,275
46,620
5,231
63,329
60,609
2,010
7,524
3,586
5,451
9,981
10,140
9,766
4,611
22,304
474
10,235
4,499
16,491
142,069
400
692
33,099
38,537
3,443
20,264
6,940
3,928
298,444
5,439
4,076
299
784
4,062
109
2,976
2,051
4,334
39,922
1 1 ,362
22,782
65 and over
25,954
11,450
16,018
2,027
7,170
1,588
1,809
1,279
228
1,822
1,401
754
768
373
7,628
846
10,238
9,564
315
1,171
554
828
1,518
1,544
1,462
683
3,275
69
1,481
647
2,349
20,196
55
95
4,407
5,128
454
2,649
890
504
37,196
653
481
35
91
470
12
332
225
465
4,244
1,181
2,279
Percent
65 and over
20.4
19.7
19.4
19.0
17.7
17.6
17.4
17.3
17.2
17.2
17.1
16.8
16.5
16.4
16.4
16.2
16.2
15.8
15.7
15.6
15.5
15.2
15.2
15.2
15.0
14.8
14.7
14.6
14.5
14.4
14.2
14.2
13.7
13.7
13.3
13.3
13.2
13.1
12.8
12.8
12.5
12.0
11.8
11.7
11.6
11.6
11.2
11.1
11.0
10.7
10.6
10.4
10.0
Note: Table excludes countries and areas with less than 100,000 population.
Source: U.S. Census Bureau, International Data Base, 2007.
-------
INDICATOR 1
Number of Older Americans continued
Table Id. Percentage of the population age 65 and over, by State, July 1,2006
State
(Ranked alphabetically)
Percent
State
(Ranked by percentage)
Percent
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
12.4
13.4
6.8
12.8
13.9
10.8
10.0
13.4
13.4
12.3
16.8
9.7
14.0
11.5
12.0
12.4
14.6
12.9
12.8
12.2
14.6
11.6
13.3
12.5
12.1
12.4
13.3
13.8
13.3
11.1
12.4
12.9
12.4
13.1
12.2
14.6
13.3
13.2
12.9
15.2
13.9
12.8
14.2
12.7
9.9
8.8
13.3
11.6
11.5
15.3
13.0
12.2
United States
Florida
West Virginia
Pennsylvania
North Dakota
Iowa
Maine
South Dakota
Rhode Island
Arkansas
Montana
Hawaii
Connecticut
Nebraska
Missouri
Massachusetts
Ohio
Delaware
Oklahoma
Alabama
Vermont
New York
Kansas
New Jersey
Wisconsin
Oregon
Arizona
Kentucky
Tennessee
South Carolina
New Hampshire
Indiana
Michigan
Mississippi
New Mexico
District of Columbia
Wyoming
North Carolina
Minnesota
Illinois
Louisiana
Idaho
Maryland
Washington
Virginia
Nevada
California
Colorado
Texas
Georgia
Utah
Alaska
12.4
16.8
15.3
15.2
14.6
14.6
14.6
14.2
13.9
13.9
13.8
14.0
13.4
13.3
13.3
13.3
13.3
13.4
13.2
13.4
13.3
13.1
12.9
12.9
13.0
12.9
12.8
12.8
12.7
12.8
12.4
12.4
12.5
12.4
12.4
12.3
12.2
12.2
12.1
12.0
12.2
11.5
11.6
11.5
11.6
11.1
10.8
10.0
9.9
9.7
8.8
6.8
Reference population: These data refer to the resident population.
Source: U.S. Census Bureau, Population Division, Table 1. Estimates of the population by selected age groups for the
United States and Puerto Rico: July 1,2006 (SC-EST2006-01).
-------
INDICATOR 1
Number of Older Americans continued
Table 1 e. Percentage of the population age 65 and over, by county, 2006
Source: U.S. Census Bureau, July 1,2006 Population Estimates.
Data for this table can be found at www.agingstats.gov.
Table If. Number and percentage of people age 65
and over and 85 and over, by sex, 2006
65 and over
Total
Men
Women
85 and over
Total
Men
Women
Millions
37,260,352
1 5,656,876
21,603,476
5,296,817
1,688,278
3,608,539
Percent
100.0
42.0
58.0
100.0
31.9
68.1
Reference population: These data refer to the resident population.
Source: U.S. Census Bureau, Population Division.Table 2: Annual estimates of the population by selected age
groups and sex for the United States: April 1,2000 to July 1,2006 (NC-EST2006-02).
INDICATOR 2
Racial and Ethnic Composition
Table 2. Population age 65 and over, by race and Hispanic origin, 2006 and projected 2050
Race and Hispanic origin
2006 estimates
2050 projections
Total
Non-Hispanic white alone
Black alone
Asian alone
All other races alone or in combination
Hispanic (of any race)
Number
37,260,352
30,187,588
3,167,986
1,176,599
413,355
2,399,320
Percent
100.0
80.8
8.5
3.2
1.1
6.4
Number
86,705,637
53,159,961
10,401,575
6,776,033
2,328,390
15,178,025
Percent
100.0
61.3
12.0
7.8
2.7
17.5
Note: The term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are
not Hispanic. The term "black alone" is used to refer to people who reported being black or African American and no other race,
and the term "Asian alone" is used to refer to people who reported only Asian as their race. The use of single-race populations in
this report does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety
of approaches. The race group "All other races alone or in combination" includes American Indian and Alaska Native, alone; Native
Hawaiian and Other Pacific Islander, alone; and all people who reported two or more races.
Reference population: These data refer to the resident population.
Source: U.S. Census Bureau, Population Estimates and Projections, 2006.
-------
INDICATORS
Marital Status
Table 3. Marital status of the population age 65 and over, by age group and sex, 2007
Selected characteristic
Both sexes
Married
Widowed
Divorced
Never married
Men
Married
Widowed
Divorced
Never married
Women
Married
Widowed
Divorced
Never married
65 and over 65-74
75-84
Percent
57.7 66.8 52.7
29.7 17.7 37.5
8.7 11.4 6.4
3.9 4.1 3.5
75.3 78.4 74.1
13.1 7.7 16.6
7.5 9.6 5.5
4.0 4.3 3.9
44.5 56.9 37.8
42.2 26.1 52.0
9.6 13.0 7.0
3.7 4.0 3.2
85 and over
30.6
62.1
3.6
3.7
60.4
34.2
2.4
3.0
15.4
76.2
4.2
4.1
Note: Married includes married, spouse present; married, spouse absent; and separated.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
| INDICATOR 4
| Educational Attainment
Table 4a. Educational attainment of the population age 65 and over, selected years 1965-2007
Educational attainment
1965 1970 1975 1980 1985 1990 1995 2000 2001 2002 2003 2004 2005 2006 2007
Percent
High school graduate or more 23.5 28.3 37.3 40.7 48.2 55.4 63.8 69.5 70.0 69.9 71.5 73.1 74.0 75.2 76.1
Bachelor's degree or more 5.0 6.3 8.1 8.6 9.4 11.6 13.0 15.6 16.2 16.7 17.4 18.7 18.9 19.5 19.2
Note: A single question which asks for the highest grade or degree completed is now used to determine educational attainment. Prior to 1995,
educational attainment was measured using data on years of school completed.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
Table 4b. Educational attainment of the population age 65 and over, by sex and race and
Hispanic origin, 2007
Race and Hispanic origin
Both sexes
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
Men
Women
High school graduate or more
76.1
81.1
57.5
71.7
42.2
76.4
75.9
Bachelor's degree or more
Percent
19.2
20.5
10.3
31.6
9.0
24.7
15.0
Note: The term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are
not Hispanic. The term "black alone" is used to refer to people who reported being black or African American and no other race,
and the term "Asian alone" is used to refer to people who reported only Asian as their race. The use of single-race populations in
this report does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety
of approaches.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
-------
INDICATORS
Living Arrangements
Table 5a. Living arrangements of the population age 65 and over, by sex and race
and Hispanic origin, 2007
Selected characteristic
With spouse With other relatives With nonrelatives
Alone
Men
Total
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
Women
Total
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
Percent
72.8
74.5
57.4
83.7
65.4
42.2
44.3
25.2
46.8
38.8
5.4
3.9
10.1
6.3
16.9
17.2
13.5
32.3
30.1
33.4
2.8
2.7
3.7
2.4
3.0
2.0
2.0
2.2
3.1
2.1
19.0
18.9
28.8
7.7
14.7
38.6
40.3
40.3
20.0
25.8
Note: Living with other relatives indicates no spouse present. Living with nonrelatives indicates no spouse or other relatives
present. The term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are
not Hispanic. The term "black alone" is used to refer to people who reported being black or African American and no other race,
and the term "Asian alone" is used to refer to people who reported only Asian as their race. The use of single-race populations in
this report does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety
of approaches.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
Table 5b. Population age 65 and over living alone, by age group and sex, selected
years 1970-2007
Men
Women
Year
65-74
75 and over
65-74
75 and over
Percent
1970
1980
1990
2000
2003
2004
2005
2006
2007
11.3
11.6
13.0
13.8
15.6
15.5
16.1
16.9
16.7
19.1
21.6
20.9
21.4
22.9
23.2
23.2
22.7
22.0
31.7
35.6
33.2
30.6
29.6
29.4
28.9
28.5
28.0
37.0
49.4
54.0
49.5
49.8
49.9
47.8
48.0
48.8
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
-------
INDICATOR 6
Older Veterans
Table 6a. Percentage of people age 65 and over who are veterans, by sex and age group,
United States and Puerto Rico,1990,2000, and projected 2010
Year
65 and over
Men Women
65-74
75-84
85 and over
Men Women
Men Women
Men
Women
Percent
Estimates
1990
2000
Projections
2010
54.2
64.3
49.8
1.8
1.7
1.3
69.7
65.2
42.0
2.5
1.1
1.0
30.0
70.9
60.6
0.9
2.7
1.1
16.6
32.6
59.6
0.6
1.0
2.3
Reference population: These data refer to the resident population of the United States and Puerto Rico.
Source: U.S. Census Bureau, Decennial Census and Population Projections; Department of Veterans Affairs, VetPop2004.
Table 6b. Estimated and projected number of veterans age 65 and over, by sex and age
group, United States and Puerto Rico, 1990,2000, and projected 2010
65 and over
Total
Men
Women
65-74
Total
Men
Women
75-84
Total
Men
Women
85 and over
Total
Men
Women
1990
7,312
6,984
328
5,954
5,700
254
1,195
1,135
60
163
150
14
Estimates
2000
Number in thousands
9,723
9,374
349
5,628
5,516
112
3,667
3,460
207
427
398
30
Projections
2010
8,889
8,591
298
4,300
4,178
121
3,322
3,240
81
1,268
1,173
95
Reference population: These data refer to the resident population of the United States and Puerto Rico.
Source: Department of Veterans Affairs, VetPop2001 and VetPop2004.
-------
[INDICATOR 7 I^S^^^^^^^^^^^^^^^^^^^^^I
Table 7a.
tear
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Percentage of the population living
65 and over
35.2
na
na
na
na
na
na
28.5
29.5
25.0
25.3
24.6
21.6
18.6
16.3
14.6
15.3
15.0
14.1
14.0
15.2
15.7
15.3
14.6
13.8
12.4
12.6
12.4
12.5
12.0
11.4
12.2
12.4
12.9
12.2
11.7
10.5
10.8
10.5
10.5
9.7
9.9
10.1
10.4
10.2
9.8
10.1
9.4
Under 18
27.3
26.9
25.6
25.0
23.1
23.0
21.0
17.6
16.6
15.6
14.0
15.1
15.3
15.1
14.4
15.4
17.1
16.0
16.2
15.9
16.4
18.3
20.0
21.9
22.3
21.5
20.7
20.5
20.3
19.5
19.6
20.6
21.8
22.3
22.7
21.8
20.8
20.5
19.9
18.9
17.1
16.2
16.3
16.7
17.7
17.8
17.6
17.4
18-64
17.0
na
na
na
na
na
na
10.5
10.0
9.0
8.7
9.0
9.3
8.8
8.3
8.3
9.2
9.0
8.8
8.7
8.9
10.1
11.1
12.0
12.4
11.7
11.3
10.8
10.6
10.5
10.2
10.7
11.4
11.9
12.4
11.9
11.4
11.4
10.9
10.5
10.1
9.6
10.1
10.6
10.8
11.3
11.1
10.8
in poverty, by age group, 1959-2006
65-74
Percent
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
12.4
11.9
10.3
10.6
10.3
9.9
10.0
8.8
9.7
10.6
10.6
10.0
10.1
8.6
8.8
9.2
9.1
8.8
8.6
9.2
9.4
9.0
9.3
8.9
8.6
75-84
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
17.4
16.7
15.2
15.3
15.3
16.0
14.6
14.6
14.9
14.0
15.2
14.1
12.8
12.3
12.5
11.3
11.6
9.8
10.6
10.4
11.1
11.0
9.7
10.9
10.0
85 and over
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
21.2
21.3
18.4
18.7
17.6
18.9
17.8
18.4
20.2
18.9
19.9
19.7
18.0
15.7
16.5
15.7
14.2
14.2
14.5
13.9
13.6
13.8
12.5
13.4
11.4
na Data not available.
Note: The poverty level is based on money income and does not include noncash benefits such as food stamps. Poverty
thresholds reflect family size and composition and are adjusted each year using the annual average Consumer Price Index. For
more detail, see U.S. Census Bureau, Series P-60, No. 222. Poverty status in the Current Population Survey is based on prioryear
income.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1960-2007.
-------
INDICATOR 7
Poverty continued
Table 7b. Percentage of the population age 65 and over living in poverty, by selected
characteristics, 2006
Selected characteristic
Both sexes
Total
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
Men
Total
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
Women
Total
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
65 and
over
9.4
7.0
22.8
12.0
19.4
6.6
4.5
16.7
12.2
17.6
11.5
9.0
26.7
11.8
20.8
65 and over,
living alone
16.9
13.4
34.3
23.0
38.9
12.4
8.7
27.4
18.1
35.2
18.6
15.1
37.5
24.4
40.5
65 and over,
married couples
Percent
4.4
3.1
10.9
10.1
11.9
4.5
3.1
10.7
11.5
12.4
4.3
3.2
11.2
8.2
11.3
65-74
8.6
6.0
21.3
9.2
18.8
6.9
4.5
17.8
11.6
18.1
10.1
7.3
23.9
7.5
19.3
75 and
over
10.3
8.1
24.9
15.3
20.4
6.2
4.4
14.6
13.0
16.7
12.9
10.5
30.2
17.0
23.1
Note: The poverty level is based on money income and does not include noncash benefits such as food stamps. Poverty
thresholds reflect family size and composition and are adjusted each year using the annual average Consumer Price
Index. For more detail, see U.S. Census Bureau, Series P-60, No. 222. The term "non-Hispanic white alone" is used to refer
to people who reported being white and no other race and who are not Hispanic. The term "black alone" is used to refer
to people who reported being blacker African American and no other race, and the term "Asian alone" is used to refer to
people who reported only Asian as their race. The use of single-race populations in this report does not imply that this is
the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2007.
-------
INDICATORS
Income
Table 8a. Income distribution of the population age 65 and over,
1974-2006
Year
Poverty
Low income Middle income High income
Percent
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
14.6
15.3
15.0
14.1
14.0
15.2
15.7
15.3
14.6
13.8
12.4
12.6
12.4
12.5
12.0
11.4
12.2
12.4
12.9
12.2
11.7
10.5
10.8
10.5
10.5
9.7
9.9
10.1
10.4
10.2
9.8
10.1
9.4
34.6
35.0
34.7
35.9
33.4
33.0
33.5
32.8
31.4
29.7
30.2
29.4
28.4
27.8
28.4
29.1
27.0
28.0
28.6
29.8
29.5
29.1
29.5
28.1
26.8
26.2
27.5
28.1
28.0
28.4
28.1
26.6
26.2
32.6
32.3
31.8
31.5
34.2
33.6
32.4
33.1
33.3
34.1
33.8
34.6
34.4
35.1
34.5
33.6
35.2
36.3
35.6
35.0
35.6
36.1
34.7
35.3
35.3
36.4
35.5
35.2
35.3
33.8
34.5
35.2
35.7
18.2
17.4
18.5
18.5
18.5
18.2
18.4
18.9
20.7
22.4
23.6
23.4
24.8
24.7
25.1
25.9
25.6
23.3
22.9
23.0
23.2
24.3
25.1
26.0
27.5
27.7
27.1
26.7
26.2
27.6
27.5
28.1
28.6
Note: The income categories are derived from the ratio of the family's income (or an unrelated
individual's income) to the corresponding poverty threshold. Being in poverty is measured as
income less than 100 percent of the poverty threshold. Low income is between 100 percent and 199
percent of the poverty threshold. Middle income is between 200 percent and 399 percent of the
poverty threshold. High income is 400 percent or more of the poverty threshold. Income distribution
in the Current Population Survey is based on prior year income.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement,
1975-2007.
-------
INDICATORS
Income continued
Table 8b. Median income of householders age 65 and over, in current and
2006 dollars, 1974-2006
Year
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Number
(in thousands)
14,263
14,802
14,816
15,225
15,795
16,544
16,912
17,312
17,671
17,901
18,155
18,596
18,998
1 9,41 2
19,716
20,156
20,527
20,921
20,682
20,806
21,365
21,486
21,408
21,497
21,589
22,478
22,469
22,476
22,659
23,048
23,151
23,459
23,729
Current
dollars
5,292
5,585
5,962
6,347
7,081
7,879
8,781
9,903
11,041
11,718
1 2,799
1 3,254
1 3,845
1 4,443
1 4,923
15,771
1 6,855
1 6,975
17,135
17,751
1 8,095
1 9,096
1 9,448
20,761
21,729
22,797
23,083
23,118
23,152
23,787
24,516
26,036
27,798
2006
dollars
1 9,086
18,602
18,780
18,793
20,083
20,393
20,457
21,065
22,149
22,545
23,657
23,684
24,301
24,522
24,440
24,760
25,206
24,507
24,126
24,390
24,343
25,086
24,886
26,004
26,842
27,586
27,026
26,328
25,947
26,077
26,169
26,890
27,798
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement,
1975-2007.
-------
INDICATOR 9
Sources of Income
Table 9a. Distribution of sources of income for married couples and
nonmarried people who are age 65 and over, selected years 1962-2006
Year
Total
Social Security
Asset income
Pensions
Earnings
Other
Percent
1962
1967
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
1999
2000
2001
2002
2003
2004
2005
2006
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
31
34
39
38
39
39
38
38
38
36
40
42
40
38
38
38
39
39
39
39
37
37
16
15
18
19
22
25
28
26
25
24
21
18
18
20
19
18
16
14
14
13
13
15
9
12
16
16
16
15
15
16
17
18
20
19
19
19
19
18
18
19
19
20
19
18
28
29
23
23
19
18
16
17
17
18
17
18
20
21
21
23
24
25
25
26
28
28
16
10
4
4
4
3
3
3
3
4
2
3
3
2
3
3
3
3
2
2
3
3
Note: A married couple is age 65 and over if the husband is age 65 and over or the husband is younger than age 55
and the wife is age 65 and over.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Social Security Administration, 1963 Survey of the Aged, and 1968 Survey of Demographic and Economic
Characteristics of the Aged; U.S. Census Bureau, Current Population Survey, Annual Social and Economic
Supplement, 1977-2007.
Table 9b. Sources of income for married couples and nonmarried people
who are age 65 and over, by income quintile, 2006
Income source
Total
Social Security
Asset income
Pensions
Earnings
Public assistance
Other
Lowest
fifth
100.0
82.5
3.3
3.9
1.6
7.5
1.3
Second
fifth
100.0
79.4
4.9
9.0
3.4
1.7
1.5
Third
fifth
Percent
100.0
64.9
7.7
16.0
8.7
0.5
2.3
Fourth
fifth
100.0
45.0
10.0
24.1
18.1
0.2
2.5
Highest
fifth
100.0
17.6
20.8
18.3
41.3
0.1
2.0
Note: A married couple is age 65 and over if the husband is age 65 and over or the husband is younger than age 55
and the wife is age 65 and over. Quintile limits are $11,519, $18,622, $28,911, and $50,064.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2007.
-------
INDICATOR 9
Sources of Income continued
Table 9c. Percentage of people age 55 and over with family income from specified sources,
by age group, 2006
Age 65 and over
Source of family income
Earnings
Wages and salaries
Self-employment
Retirement benefits
Social Security
Benefits other than Social Security
Other public pensions
Railroad Retirement
Government employee pensions
Military
Federal
State or local
Private pensions or annuities
Income from assets
Interest
Other income from assets
Dividends
Renter royalties
Estates or trusts
Veterans' benefits
Unemployment compensation
Workers' compensation
Combined public assistance and
noncash benefits
Public assistance
Supplemental Security Income
Other cash benefits
Noncash benefits
Food
Energy
Housing
Personal contributions
55-61
85.6
81.6
13.9
33.8
21.5
20.2
9.1
0.3
8.9
1.7
2.0
5.5
12.0
60.6
58.3
31.0
26.8
9.3
0.3
3.7
4.9
1.6
8.8
5.2
4.6
0.8
5.7
3.9
1.5
2.0
2.1
Number (thousands) 24,314
62-64
69.9
65.7
10.7
65.7
55.4
35.9
14.6
0.7
14.0
2.3
3.0
9.4
23.1
60.8
58.3
30.5
26.2
9.1
0.2
3.4
3.3
1.3
10.1
5.8
5.5
0.3
6.5
4.1
1.6
3.0
1.7
7,877
Total
36.2
32.7
6.4
92.6
89.9
44.7
15.6
0.5
15.1
2.2
4.0
9.6
31.9
60.1
57.6
27.5
23.1
8.7
0.3
4.2
1.4
0.7
10.2
4.5
4.2
0.4
7.7
3.4
2.3
4.0
1.2
36,035
65-69
53.1
48.2
9.4
88.0
84.6
41.0
14.8
0.4
14.5
1.8
3.6
9.7
29.1
61.6
59.1
29.8
25.0
9.6
0.3
3.2
2.1
1.1
9.1
4.5
4.1
0.6
6.6
3.7
1.9
3.1
1.3
10,629
70-74
39.2
35.5
6.5
93.4
91.3
47.1
15.2
0.4
14.8
2.4
4.0
9.2
34.6
60.5
57.9
27.9
23.4
8.6
0.3
3.9
1.7
0.6
10.5
4.7
4.4
0.4
7.8
3.5
2.5
3.8
1.1
8,369
75-79
29.1
25.5
6.0
94.8
92.4
46.5
16.2
0.6
15.6
2.7
3.7
10.0
33.1
59.8
57.5
27.2
23.0
8.9
0.2
4.3
1.1
0.5
9.9
4.4
4.2
0.3
7.5
3.4
2.1
4.1
0.8
7,567
80 and over
20.3
18.4
3.2
95.2
92.7
45.4
16.3
0.8
15.7
2.1
4.8
9.5
31.6
58.3
55.9
24.7
20.6
7.6
0.3
5.5
0.8
0.4
11.6
4.4
4.1
0.4
9.2
3.1
2.6
5.2
1.4
9,471
Reference population: These data refer to the civilian noninstitutionalized population.
Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2007.
-------
INDICATOR 10
Net Worth
Table 10. Median household net worth of head of household, by selected
characteristics, in 2005 dollars, selected years 1984-2005
Selected characteristic
Age of family head
65 and over
45-54
55-64
65-74
75 and over
1984
$109,000
1 29,700
1 39,700
128,100
94,000
1989
$118,900
1 1 5,400
1 75,600
148,100
98,400
1994
$131,800
1 1 7,300
183,800
1 52,900
108,900
1999
In dollars
$177,200
104,300
168,800
206,300
1 50,1 00
200?
$198,300
107,000
182,000
226,100
1 58,800
2003
$192,400
1 07,000
1 85,700
207,500
169,800
2005
$196,000
108,300
201,000
218,500
181,000
Marital status, family head age 65 and over
Married
Unmarried
171,100
77,100
216,600
72,500
242,200
81,500
276,700
106,200
320,900
111,200
322,700
110,900
328,300
104,000
Race, family head age 65 and over
White
Black
1 25,000
28,200
135,500
36,500
145,000
40,900
206,300
32,800
226,100
45,200
228,200
27,900
226,900
37,800
Education, family head age 65 and over
No high school diploma
High school diploma only
Some college or more
60,900
1 50,900
238,700
60,300
160,500
275,600
65,900
142,300
296,500
64,500
187,600
352,900
63,200
1 89,700
397,500
63,200
1 70,900
399,600
59,500
184,000
412,100
Note: Median net worth is calculated using sample weights. Tests of statistical significance were performed on the mean household net
worth. From 1984 to 1994, net equity in homes and nonhousing assets was divided into six categories: other real estate and vehicles;
farm or business ownership; stocks, mutual funds, investment trusts, and stocks held in IRAs; checking and savings accounts, CDs,
treasury bills, savings bonds, and liquid assets in IRAs; bonds, trust life insurance, and other assets; and debts. Starting in 1999, IRAs
were measured as a separate category. Panel Study of Income Dynamics (PSID) net worth data do not include pension wealth. This
excludes private defined-contribution and defined-benefit plans as well as rights to Social Security wealth. Data for 1984-2003 have
been inflation adjusted to 2005 dollars. See Appendix B for the definition of race and Hispanic origin in the PSID.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Panel Study of Income Dynamics.
-------
INDICATOR 11
Participation in the Labor Force
Table 11. Labor force participation rates of people age 55 and over, by age group
and sex, annual averages, 1963-2006
Men
Year
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
55-6?
89.9
89.5
88.8
88.6
88.5
88.4
88.0
87.7
86.9
85.6
84.0
83.4
81.9
81.1
80.9
80.3
79.5
79.1
78.4
78.5
77.7
76.9
76.6
75.8
76.3
75.8
76.3
76.7
76.1
75.7
74.9
73.8
74.3
74.8
75.4
75.5
75.4
74.3
74.9
75.4
74.9
74.4
74.7
75.2
62-64
75.8
74.6
73.2
73.0
72.7
72.6
70.2
69.4
68.4
66.3
62.4
60.8
58.6
56.1
54.6
54.0
54.3
52.6
49.4
48.0
47.7
47.5
46.1
45.8
46.0
45.4
45.3
46.5
45.5
46.2
46.1
45.1
45.0
45.7
46.2
47.3
46.9
47.0
48.2
50.4
49.5
50.8
52.5
52.4
65-69
40.9
42.6
43.0
42.7
43.4
43.1
42.3
41.6
39.4
36.8
34.1
32.9
31.7
29.3
29.4
30.1
29.6
28.5
27.8
26.9
26.1
24.6
24.4
25.0
25.8
25.8
26.1
26.0
25.1
26.0
25.4
26.8
27.0
27.5
28.4
28.0
28.5
30.3
30.2
32.2
32.8
32.6
33.6
34.4
70 and over
Percent
20.8
19.5
19.1
17.9
17.6
17.9
18.0
17.6
16.9
16.6
15.6
15.5
15.0
14.2
13.9
14.2
13.8
13.1
12.5
12.2
12.2
11.4
10.5
10.4
10.5
10.9
10.9
10.7
10.5
10.7
10.3
11.7
11.6
11.5
11.6
11.1
11.7
12.0
12.1
11.5
12.3
12.8
13.5
13.9
55-6?
43.7
44.5
45.3
45.5
46.4
46.2
47.3
47.0
47.0
46.4
45.7
45.3
45.6
45.9
45.7
46.2
46.6
46.1
46.6
46.9
46.4
47.1
47.4
48.1
48.9
49.9
51.4
51.7
52.1
53.6
53.8
55.5
55.9
56.4
57.3
57.6
57.9
58.3
58.9
61.1
62.5
62.1
62.7
63.8
Women
62-64
28.8
28.5
29.5
31.6
31.5
32.1
31.6
32.3
31.7
30.9
29.2
28.9
28.9
28.3
28.5
28.5
28.8
28.5
27.6
28.5
29.1
28.8
28.7
28.5
27.8
28.5
30.3
30.7
29.3
30.5
31.7
33.1
32.5
31.8
33.6
33.3
33.7
34.1
36.7
37.6
38.6
38.7
40.0
41.5
65-69
16.5
17.5
17.4
17.0
17.0
17.0
17.3
17.3
17.0
17.0
15.9
14.4
14.5
14.9
14.5
14.9
15.3
15.1
14.9
14.9
14.7
14.2
13.5
14.3
14.3
15.4
16.4
17.0
17.0
16.2
16.1
17.9
17.5
17.2
17.6
17.8
18.4
19.5
20.0
20.7
22.7
23.3
23.7
24.2
70 and over
5.9
6.2
6.1
5.8
5.8
5.8
6.1
5.7
5.6
5.4
5.3
4.8
4.8
4.6
4.6
4.8
4.6
4.5
4.6
4.5
4.5
4.4
4.3
4.1
4.1
4.4
4.6
4.7
4.7
4.8
4.7
5.5
5.3
5.2
5.1
5.2
5.5
5.8
5.9
6.0
6.4
6.7
7.1
7.1
Note: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years due to a redesign
of the survey and methodology of the Current Population Survey. Beginning in 2000, data incorporate population
controls from Census 2000.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Bureau of Labor Statistics, Current Population Survey.
-------
INDICATOR 12
Total Expenditures
Table 12. Percentage of total household annual expenditures by age of reference
person, 2005
45-54
55-64
65 and over
65-74
75 and over
Personal insurance and pensions
Healthcare
Transportation
Housing
Food
Other
13.2
4.8
17.5
30.9
12.5
21.1
11.9
6.9
18.0
31.8
12.5
18.9
5.4
12.8
15.7
33.6
12.7
19.8
6.7
10.8
17.0
32.3
12.7
20.4
3.5
15.6
13.9
35.6
12.5
18.9
Note: Other expenditures include apparel, personal care, entertainment, reading, education, alcohol, tabacco, cash contributions, and
miscellaneous expenditures. Data from the Consumer Expenditure Survey by age group represent average annual expenditures for
consumer units by the age of reference person, who is the person listed as the owner or renter of the home. For example, the data on
people age 65 and over reflect consumer units with a reference person age 65 or older. The Consumer Expenditure Survey collects and
publishes information from consumer units, which are generally defined as a person or group of people who live in the same household
and are related by blood, marriage, or other legal arrangement (i.e., a family), or people who live in the same household but who are
unrelated and financially independent from one another (e.g., roommates sharing an apartment). A household usually refers to a physical
dwelling, and may contain more than one consumer unit. However, for convenience the term "household" is substituted for "consumer
unit" in this text.
Reference population: These data refer to the resident noninstitutionalized population.
Source: Bureau of Labor Statistics, Consumer Expenditure Survey.
INDICATOR 13
Housing Problems
Table 13a. Percentage of households with residents age 65 and over that report housing
problems, by type of problem, selected years 1985-2005
Households
People*
Households with a resident age 65 and over
Numbers in 1 OOOs Percent
Numbers in 1 OOOs Percent
1985
Total 20,912 100
Number and percent with
One or more of the housing problems 7,522 36
Housing cost burden (> 30 percent) 6,251 30
Physically inadequate housing 1,737 8
Crowded housing 193 1
Total 22,017 100
Number and percent with
One or more of the housing problems 7,315 33
Housing cost burden (> 30 percent) 6,056 28
Physically inadequate housing 1,706 8
Crowded housing 148 1
1989
27,375
9,118
7,498
2,131
238
29,372
8,995
7,394
2,117
180
1995
100
33
27
8
1
100
31
25
7
1
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
22,791
7,841
6,815
1,402
150
100
34
30
6
1
30,328
9,590
8,290
1,731
199
100
32
27
6
1
See footnotes at end of table.
-------
INDICATOR 13
Housing Problems continued
Table 13a. Percentage of households with residents age 65 and over that report housing
problems, by type of problem, selected years 1985-2005 (continued)
Households
Households with a resident age 65 and over
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Numbers in 1000s
22,975
8,566
7,642
1,321
165
23,589
8,534
7,635
1,337
173
24,038
9,154
8,312
1,269
222
24,140
8,718
7,794
1,230
225
24,983
10,153
9,400
1,188
153
People*
Percent Numbers in 1000s
1997
100
37
33
6
1
1999
100
36
32
6
1
2001
100
38
35
5
1
2003
100
36
32
5
1
2005
100
41
38
5
1
30,776
10,715
9,539
1,592
224
31,487
10,750
9,641
1,627
209
31,935
11,577
10,501
1,567
288
32,163
10,967
9,808
1,516
300
33,268
1 2,649
11,672
1,486
189
Percent
100
35
31
5
1
100
34
31
5
1
100
36
33
5
1
100
34
30
5
1
100
38
35
4
1
*Number of people age 65 and over. The American Housing Survey (AHS) universe is limited to the household population and excludes the
population living in nursing homes, college dormitories, and other group quarters. The AHS is a representative sample of approximately
60,000 households in the United States and because it is a statistical sample, the estimates presented are subject to both sampling
and nonsampling errors. Because the AHS is a household survey, its population estimates are likely to differfrom estimates based on a
population survey. The estimated number of households with a resident age 65 and over reflects changes in Census weights: 1985 and
1989 data are consistent with 1980 Census weights; 1995,1997,1999 data with 1990 Census weights; and 2001,2003, and 2005 with 2000
Census weights.
Note: Data are available biennially for odd years. Housing cost burden is defined as expenditures on housing and utilities in excess of 30
percent of reported income. Physical problem categories include plumbing, heating, electricity, hallways, and upkeep. See definition in
Appendix A of the American Housing Survey summary volume, American Housing Survey for the United States in 2005, Current Housing
Reports, H150/05, U.S. Census Bureau, 2006. Crowded housing is defined as housing in which there is more than one person per room in a
residence. The subcategories for housing problems do not add to the total number with housing problems because a household may have
more than one housing problem.
Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes
are excluded.
Source: U.S. Census Bureau and the U.S. Department of Housing and Urban Development, American Housing Survey.Tabulated by U.S.
Department of Housing and Urban Development.
-------
INDICATOR 13
Housing Problems continued
Table 13b. Percentage of all U.S. households that report housing problems, by type of
problem, selected years 1985-2005
Households
Households with a resident age 65 and over
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Numbers in WOOs
88,425
28,709
22,633
7,374
2,496
93,683
28,270
21,690
7,603
2,676
97,694
32,385
26,950
6,370
2,554
99,487
33,402
27,445
6,988
2,806
1 02,803
33,953
28,204
6,878
2,571
1 05,435
35,937
30,253
6,611
2,631
People*
Percent Numbers in WOOs
1985
100
32
26
8
3
1989
100
30
23
8
3
1995
100
33
28
7
3
1997
100
34
28
7
3
1999
100
33
27
7
3
2001
100
34
29
6
2
234,545
76,447
55,055
20,357
15,071
248,028
75,430
52,449
20,694
16,187
254,160
85,327
65,835
1 7,432
15,375
257,542
86,559
65,997
18,441
16,860
262,463
86,569
66,945
17,310
1 5,563
269,102
91,948
71,950
16,709
16,070
Percent
100
33
23
9
6
100
30
21
8
7
100
34
26
7
6
100
34
26
7
7
100
33
26
7
6
100
34
27
6
6
See footnotes at end of table.
-------
INDICATOR 13
Housing Problems continued
Table 13b. Percentage of all U.S. households that report housing problems, by type of
problem, selected years 1985-2005 (continued)
Households
Households with a resident age 65 and over
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Numbers in WOOs
1 05,867
36,401
31,044
6,281
2,559
108,901
40,779
35,835
6,199
2,621
People*
Percent Numbers in WOOs
2003
100
34
29
6
2
2005
100
37
33
6
2
269,508
92,516
74,088
1 5,364
1 5,589
277,085
102,921
85,542
14,846
16,032
Percent
100
34
27
6
6
100
37
31
5
6
* The American Housing Survey (AHS) universe is limited to the household population and excludes the population living in nursing
homes, college dormitories, and other group quarters. The AHS is a representative sample of approximately 60,000 households in the
United States and because it is a statistical sample, the estimates presented are subject to both sampling and nonsampling errors. Because
the AHS is a household survey, its population estimates are likely to differ from estimates based on a population survey. The estimated
number of households reflects changes in Census weights: 1985 and 1989 data are consistent with 1980 Census weights; 1995,1997,1999
data with 1990 Census weights; and 2001,2003, and 2005 with 2000 Census weights.
Note: Data are available biennially for odd years. Housing cost burden is defined as expenditures on housing and utilities in excess of 30
percent of reported income. Physical problem categories include plumbing, heating, electricity, hallways, and upkeep. See definition in
Appendix A of the American Housing Survey summary volume, American Housing Survey for the United States in 2005, Current Housing
Reports, H150/05, U.S. Census Bureau, 2006. Crowded housing is defined as housing in which there is more than one person per room in a
residence. The subcategories for housing problems do not add to the total number with housing problems because a household may have
more than one housing problem.
Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes
are excluded.
Source: U.S. Census Bureau and the U.S. Department of Housing and Urban Development, American Housing Survey.Tabulated by U.S.
Department of Housing and Urban Development.
-------
INDICATOR 14
Life Expectancy
Table 14a. Life expectancy, by age and sex, selected years 1900-2004
Ageandsex 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2001 2002 2003 2004
Years
Birth
Both sexes
Men
Women
At age 65
Both sexes
Men
Women
At age 85
Both sexes
Men
Women
49.2
47.9
50.7
11.9
11.5
12.2
4.0
3.8
4.1
51.5
49.9
53.2
11.6
11.2
12.0
4.0
3.9
4.1
56.4
55.5
57.4
12.5
12.2
12.7
4.2
4.1
4.3
59.2
57.7
60.9
12.2
11.7
12.8
4.2
4.0
4.3
63.6
61.6
65.9
12.8
12.1
13.6
4.3
4.1
4.5
68.1
65.5
71.0
13.8
12.7
15.0
4.7
4.4
4.9
69.9
66.8
73.2
14.4
13.0
15.8
4.6
4.4
4.7
70.8
67.0
74.6
15.0
13.0
16.8
5.3
4.7
5.6
73.9
70.1
77.6
16.5
14.2
18.4
6.0
5.1
6.4
75.4
71.8
78.8
17.3
15.1
19.0
6.2
5.3
6.7
77.0
74.3
79.7
18.0
16.2
19.3
6.4
5.6
6.8
77.2
74.4
79.8
18.1
16.4
19.4
6.5
5.7
6.9
77.3
74.5
79.9
18.2
16.6
19.5
6.5
5.7
6.9
77.4
74.7
80.0
18.4
16.8
19.7
6.6
5.9
7.0
77.8
75.2
80.4
18.7
17.1
20.0
6.8
6.1
7.2
Note: The life expectancies (LEs) for decennial years 1910 to 1990 are based on decennial census data and deaths for a 3-year period around
the census year. The LEs for decennial year 1900 are based on deaths from 1900 to 1902. LEs for years prior to 1930 are based on the death
registration area only. The death registration area increased from 10 States and the District of Columbia in 1900 to the coterminous United
States in 1933. LEs for 2000 were computed using population counts from Census 2000. LEs for 2001 -2004 were computed using 2000-based
postcensal estimates.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
Table 14b. Life expectancy, by age and race, 2004
Total
Age
White
Black
Men
White
Black
Women
White
Black
Years
Birth
At age 65
At age 85
78.3
18.7
6.7
73.1
17.1
7.1
75.7
17.2
6.0
69.5
15.2
6.3
80.8
20.0
7.1
76.3
18.6
7.5
Note: See Appendix B for the definition of race and Hispanic origin in the National Vital Statistics System.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
-------
INDICATOR 14
Life Expectancy continued
Table 14c. Average life expectancy at age 65, by sex and selected countries or areas,
C0l0rt0rl vparc 1Q8O-7nn^
selected years 1980-2003
Years of life remaining
for people who reach
age 65
Australia
Austria
Belgium
Bulgaria
Canada
Chile
Costa Rica
Cuba
Czech Republic(1)
Denmark
England and Wales(2)
Finland
France
Germany(3)
Greece
Hong Kong
Hungary
Ireland
Israel
Italy
Japan
Netherlands
New Zealand
Northern lreland(2)
Norway
Poland
Portugal
Romania
Russian Federation
Scotland(2)
Singapore
Slovakia(1)
Spain
Sweden
Switzerland
United States
1980
13.7
12.9
13.0
12.7
14.5
—
16.1
—
11.2
13.6
12.9
12.5
13.6
13.0
14.6
13.9
11.6
12.6
14.4
13.3
14.6
13.7
13.2
11.9
14.3
12.0
12.9
12.6
11.6
12.3
12.6
12.3
14.8
14.3
14.4
14.1
Men
Year
1990
15.2
14.3
14.3
12.9
15.7
14.6
17.1
—
11.6
14.0
14.1
13.7
15.5
14.0
15.7
15.3
12.0
13.3
15.9
15.1
16.2
14.4
14.7
13.7
14.6
12.7
13.9
13.3
12.1
13.1
14.5
12.2
15.4
15.3
15.3
15.1
Women
2000
16.9
16.0
15.5
12.8
16.8
15.3
17.2
16.7
13.7
15.2
15.8
15.5
16.7
15.7
16.3
17.3
12.7
14.6
16.9
16.5
17.5
15.3
16.7
15.3
16.0
13.6
15.3
13.5
11.1
14.7
15.8
12.9
16.6
16.7
16.9
16.3
2003
17.6
16.3
15.8
13.8
17.4
15.4
17.7
16.9
13.9
15.5
16.5
15.8
17.1
16.1
16.8
17.9
13.0
15.7
17.3
16.6
18.0
15.8
17.1
16.1
16.7
13.9
15.6
13.1
10.7
15.2
17.0
13.3
16.8
17.0
17.5
16.8
1980
17.9
16.3
16.9
14.7
18.9
—
18.1
—
14.3
17.6
16.9
16.5
18.2
16.7
16.8
13.9
14.6
15.7
15.8
17.1
17.7
18.0
17.0
15.8
18.0
15.5
16.5
14.2
15.6
16.2
15.4
15.4
17.9
17.9
17.9
18.3
Year
1990
19.0
17.8
18.5
15.4
19.9
17.6
19.3
—
15.2
17.8
17.9
17.7
19.8
17.6
18.0
18.8
15.3
16.9
17.8
18.8
20.0
18.9
18.3
17.5
18.5
16.9
17.0
15.3
15.9
16.7
16.9
15.7
19.0
19.0
19.4
18.9
2000
20.4
19.4
19.5
15.4
20.4
18.6
19.6
19.0
17.1
18.3
19.0
19.3
21.2
19.4
18.3
21.5
16.5
17.8
19.3
20.4
22.4
19.2
20.0
18.5
19.7
17.3
18.7
15.9
15.2
17.8
19.0
16.5
20.4
20.0
20.7
19.2
2003
21.0
19.9
19.7
15.9
20.8
18.7
20.0
19.3
17.3
18.6
19.4
19.6
21.4
19.6
18.9
21.7
16.9
18.9
19.7
20.6
23.0
19.5
20.1
19.1
20.1
17.9
18.9
15.9
14.9
18.2
19.7
16.9
20.7
20.3
21.0
19.8
— Data not available.
(1) In 1993,Czechoslovakia was divided into two nations, the Czech Republic and Slovakia. Data for 1980 and 1990 refer to the respective
Czech and Slovak regions of the former Czechoslovakia. (2) Different geographic constituents of the United Kingdom may have separate
statistical systems. This table includes data for three such areas: England and Wales, Northern Ireland, and Scotland. (3) Data for 1980 and
1990 refer to the former Federal Republic of Germany (West Germany); from 2000 on wards, data refer to Germany after reunification.
Note: Countries or areas in this table have populations of at least one million and death registrations that are at least 90 percent complete.
However, this table is not a comprehensive listing of all countries with these characteristics; for details see Health, United States, 2007.]0
Therefore, it is inappropriate to infer global rankings from these data.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Health, UnitedStates, 2007.]0
-------
INDICATOR 15 IJBB^^^^^^^^^^^^^^^^^^^^^H
Table 15a. Death rates for selected leading causes of death
over, 198 1-2004
among people age 65 and
Chronic lower
Year
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Total
5,713.9
5,609.7
5,685.4
5,644.8
5,693.8
5,628.7
5,577.7
5,625.0
5,456.9
5,352.8
5,290.7
5,205.2
5,348.6
5,269.9
5,264.7
5,221.7
5,178.9
5,168.1
5,220.0
5,137.2
5,044.1
5,000.5
4,907.2
4,698.8
Diseases of
heart
2,546.7
2,503.2
2,512.0
2,449.5
2,430.9
2,371.7
2,316.4
2,305.7
2,171.8
2,091.1
2,045.6
1,989.5
2,024.0
1,952.3
1,927.4
1,877.6
1,827.2
1,791.5
1,767.0
1,694.9
1,631.6
1,585.2
1,524.9
1,418.2
Malignant
neoplasm
1,055.7
1 ,068.9
1 ,077.5
1,087.1
1,091.2
1,101.2
1,105.5
1,114.1
1,133.0
1,141.8
1,149.5
1,150.6
1,159.2
1,155.3
1,152.5
1 ,1 40.8
1,127.3
1,119.2
1,126.1
1,119.2
1,100.2
1 ,090.9
1 ,073.0
1,051.7
Cerebrovascular respiratory
diseases
Number per
623.8
585.2
564.4
546.2
531.0
506.3
495.9
489.4
463.7
447.9
434.7
424.5
434.5
433.7
437.7
433.1
423.8
411.9
433.2
422.7
404.1
393.2
372.8
346.2
diseases
Influenza and
pneumonia
Diabetes
mellitus
Alzheimer's
disease
100,000 population
185.8
186.1
204.3
210.8
225.4
227.7
229.7
240.0
240.2
245.0
251.7
252.5
273.6
271.3
271.2
275.5
280.2
286.8
313.0
303.6
300.7
300.6
299.1
284.3
207.2
181.2
207.2
214.0
242.9
244.7
237.4
263.1
253.3
258.2
245.1
232.7
247.9
238.1
237.2
233.5
236.3
247.4
167.4
167.2
154.9
160.7
154.8
139.0
105.8
102.3
104.4
102.6
103.4
100.8
102.3
104.7
120.4
120.4
120.8
120.8
128.4
132.6
135.9
139.4
140.2
143.4
150.0
149.6
151.1
152.0
150.7
146.0
6.0
9.2
16.3
23.5
31.0
35.0
41.8
44.7
47.3
48.7
48.7
48.8
55.3
59.8
64.9
65.9
67.7
67.0
128.8
139.9
148.3
158.7
167.7
170.6
Percentage change between 1981-2004
-17.8
-44.3
-0.4
-44.5
53.0
-32.9
38.0
*32.5
"Change calculated from 1999 when ICD-10 was implemented.
Note: Death rates for 1981 -1998 are based on the 9th revision of the International Classification of Diseases (ICD-9). Starting in 1999,
death rates are based on ICD-10. For the period 1981 -98, causes were coded using ICD-9 codes that are most nearly comparable with the
113 cause list for ICD-10 and may differ from previously published estimates. Population estimates for July 1,2000, and July 1,2001, are
postcensal estimates and have been bridged to be consistent with the race categories used in the 1990 Decennial Census. These estimates
were produced by the National Center for Health Statistics under a collaborative arrangement with the U.S. Census Bureau. Population
estimates for 1990-1999 are intercensal estimates, based on the 1990 Decennial Census and bridged estimates for 2000. These estimates
were produced by the Population Estimates Program of the U.S. Census Bureau with support from the National Cancer Institute (NCI). For
more information on the bridged race population estimates for 1990-2001, see www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.
htm. Death rates for 1990-2001 may differ from those published elsewhere because of the use of the bridged intercensal and postcensal
population estimates. Rates are age adjusted using the 2000 standard population.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
-------
INDICATOR 15
Mortality continued
Table 15b. Leading causes of death among people age 65 and over, by sex and race and
Hispanic origin, 2004
All races
White
Black
Asian or Pacific
Islander
American
Indian
Hispanic
Men
1 Diseases of heart
2 Malignant
neoplasms
3 Chronic lower
respiratory diseases
4 Cerebrovascular
diseases
5 Diabetes mellitus
6 Influenza and
pneumonia
Diseases of heart Diseases of heart
Malignant
neoplasms
Chronic lower
respiratory diseases
Cerebrovascular
diseases
Influenza and
pneumonia
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Chronic lower
respiratory diseases
Diabetes mellitus Nephritis
7 Alzheimer's disease Alzheimer's disease
8 Unintentional
injuries
9 Nephritis
10 Septicemia
11 Parkinson's disease
12 Pneumonitis
13 Hypertension
14 Aortic aneurysm
15 Liver disease
16 Benign neoplasms
17 Suicide
18 Atherosclerosis
19 Anemias
20 Peptic ulcer
Unintentional
injuries
Nephritis
Parkinson's disease
Septicemia
Pneumonitis
Aortic aneurysm
Hypertension
Liver disease
Benign neoplasms
Suicide
Atherosclerosis
Anemias
Peptic ulcer
Influenza and
pneumonia
Septicemia
Unintentional
injuries
Hypertension
Alzheimer's disease
Pneumonitis
Liver disease
Parkinson's disease
Aortic aneurysm
Benign neoplasms
Atherosclerosis
HIV
Suicide
Homicide
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory diseases
Influenza and
pneumonia
Diabetes mellitus
Nephritis
Unintentional
injuries
Diseases of heart Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus Diabetes mellitus
Chronic lower
respiratory diseases
Influenza and
pneumonia
Unintentional
injuries
Nephritis
Alzheimer's disease Liver disease
Hypertension
Septicemia
Parkinson's disease
Pneumonitis
Aortic aneurysm
Benign neoplasms
Liver disease
Suicide
Viral hepatitis
Atherosclerosis
Peptic ulcer
Septicemia
Alzheimer's disease
Hypertension
Parkinson's disease
Pneumonitis
Benign neoplasms
Aortic aneurysm
Atherosclerosis
Suicide
Gallbladder
disorders
'Nutritional
deficiencies
'Tuberculosis
Chronic lower
respiratory diseases
Influenza and
pneumonia
Nephritis
Unintentional
injuries
Alzheimer's disease
Liver disease
Septicemia
Hypertension
Parkinson's disease
Pneumonitis
Benign neoplasms
Aortic aneurysm
Atherosclerosis
Suicide
Gallbladder
disorders
Viral hepatitis
See footnotes at end of table.
-------
INDICATOR 15 JMiffB
continued
Table 1 5b. Leading causes of death among people age 65 and
Hispanic origin, 2004 (continued)
All races
Women
1 Diseases of heart
2 Malignant
neoplasms
3 Cerebrovascular
diseases
4 Chronic lower
respiratory diseases
5 Alzheimer's disease
6 Influenza and
pneumonia
7 Diabetes mellitus
8 Nephritis
9 Unintentional
injuries
10 Septicemia
1 1 Hypertension
12 Pneumonitis
13 Parkinson's disease
14 Atherosclerosis
15 Benign neoplasms
16 Aortic aneurysm
17 Liver disease
18 Anemias
19 Nutritional
deficiencies
20 Peptic ulcer
White
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory diseases
Alzheimer's disease
Influenza and
pneumonia
Diabetes mellitus
Unintentional
injuries
Nephritis
Septicemia
Hypertension
Parkinson's disease
Pneumonitis
Atherosclerosis
Benign neoplasms
Aortic aneurysm
Liver disease
Anemias
Peptic ulcer
Nutritional
deficiencies
Black
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Nephritis
Alzheimer's disease
Chronic lower
respiratory disease
Influenza and
pneumonia
Septicemia
Hypertension
Unintentional
injuries
Pneumonitis
Atherosclerosis
Benign neoplasms
Aortic aneurysm
Parkinson's disease
Anemias
Liver disease
Nutritional
deficiencies
Gallbladder
disorders
Asian or Pacific
Islander
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Influenza and
pneumonia
Chronic lower
respiratory disease
Alzheimer's disease
Unintentional
injuries
Nephritis
Hypertension
Septicemia
Parkinson's disease
Pneumonitis
Benign neoplasms
Aortic aneurysm
Liver disease
Atherosclerosis
Viral hepatitis
Suicide
Peptic ulcer
over, by sex and race and
American
Indian
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Chronic lower
respiratory diseases
Influenza and
pneumonia
Unintentional
injuries
Nephritis
Alzheimer's disease
Liver disease
Septicemia
Hypertension
Pneumonitis
Atherosclerosis
Parkinson's disease
Benign neoplasms
2Aortic aneurysm
2Nutritional
deficiencies
Gallbladder
disorders
Peptic ulcer
Hispanic
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Alzheimer's disease
Influenza and
pneumonia
Chronic lower
respiratory disease
Nephritis
Unintentional
injuries
Septicemia
Hypertension
Liver disease
Pneumonitis
Parkinson's disease
Benign neoplasms
Atherosclerosis
Aortic aneurysm
Gallbladder
disorders
Viral hepatitis
Anemias
'For American Indian men, Nutritional deficiencies and Tuberculosis tied for 20th.
2For American Indian women, Aortic aneurysm and Nutritional deficiencies tied for 17th.
Note: See Appendix B for the definition of race and Hispanic origin in the National Vital Statistics System.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
-------
INDICATOR 15 JMiffH
continued
Table 1 5c. Leading causes of death among people age 85 and over, by sex and
Hispanic origin, 2004
All races
Men
1 Diseases of heart
2 Malignant
neoplasms
3 Cerebrovascular
diseases
4 Chronic lower
respiratory diseases
5 Influenza and
pneumonia
6 Alzheimer's
disease
7 Nephritis
8 Unintentional
injuries
9 Diabetes mellitus
10 Pneumonitis
11 Parkinson's disease
12 Septicemia
13 Hypertension
14 Atherosclerosis
15 Benign neoplasms
16 Aortic aneurysm
17 Suicide
18 Anemias
19 Nutritional
deficiencies
20 "Gallbladder
disorders
"Liver disease
White
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory diseases
Influenza and
pneumonia
Alzheimer's
disease
Nephritis
Unintentional
injuries
Diabetes mellitus
Pneumonitis
Parkinson's disease
Septicemia
Hypertension
Atherosclerosis
Benign neoplasms
Aortic aneurysm
Suicide
Anemias
Liver disease
Gallbladder
disorders
Black
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Influenza and
pneumonia
Chronic lower
respiratory diseases
Nephritis
Diabetes mellitus
Alzheimer's disease
Septicemia
Hypertension
Unintentional
injuries
Pneumonitis
Parkinson's disease
Atherosclerosis
Benign neoplasms
Aortic aneurysm
Nutritional
deficiencies
Anemias
Pneumoconioses
Peptic ulcer
Asian or Pacific
Islander
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Influenza and
pneumonia
Chronic lower
respiratory diseases
Diabetes mellitus
Alzheimer's disease
Nephritis
Unintentional
injuries
Pneumonitis
Hypertension
Parkinson's disease
Septicemia
Aortic aneurysm
Atherosclerosis
Benign neoplasms
Suicide
Peptic ulcer
3Nutritional
deficiencies
tuberculosis
American
Indian
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Influenza and
pneumonia
Chronic lower
respiratory diseases
Unintentional
injuries
Nephritis
Diabetes mellitus
'Septicemia
'Alzheimer's
disease
Pneumonitis
Parkinson's disease
Benign neoplasms
Hypertension
'Aortic aneurysm
'Atherosclerosis
'Gallbladder
disorders
Hernia
'Anemias
'Liver disease
'Nutritional
deficiencies
race and
Hispanic
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Influenza and
pneumonia
Chronic lower
respiratory diseases
Alzheimer's
disease
Diabetes mellitus
Nephritis
Unintentional
injuries
2Septicemia
2Hypertension
Parkinson's disease
Pneumonitis
Atherosclerosis
Benign neoplasms
Aortic aneurysm
Liver disease
Anemias
'Gallbladder
disorders
2Suicide
See footnotes at end of table.
-------
INDICATOR 15
Mortality continued
Table 15c. Leading causes of death among people age 85 and over, by sex and race and
Hispanic origin, 2004 (continued)
All races
Women
1 Diseases of heart
2 Malignant
neoplasms
3 Cerebrovascular
diseases
4 Alzheimer's
disease
5 Influenza and
pneumonia
6 Chronic lower
respiratory diseases
7 Diabetes mellitus
8 Nephritis
9 Unintentional
injuries
10 Hypertension
1 1 Septicemia
12 Atherosclerosis
13 Pneumonitis
14 Parkinson's disease
15 Benign neoplasms
16 Aortic aneurysm
17 Anemias
18 Nutritional
deficiencies
19 Peptic ulcer
20 Gallbladder
disorders
White
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Influenza and
pneumonia
Chronic lower
respiratory diseases
Diabetes mellitus
Unintentional
injuries
Nephritis
Hypertension
Septicemia
Atherosclerosis
Pneumonitis
Parkinson's disease
Benign neoplasms
Aortic aneurysm
Anemias
Nutritional
deficiencies
Peptic ulcer
Gallbladder
disorders
Black
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Diabetes mellitus
Influenza and
pneumonia
Nephritis
Hypertension
Septicemia
Chronic lower
respiratory diseases
Unintentional
injuries
Pneumonitis
Atherosclerosis
Benign neoplasms
Anemias
Nutritional
deficiencies
Parkinson's disease
Aortic aneurysm
Gallbladder
disorders
Peptic ulcer
Asian or Pacific
Islander
Diseases of heart
Cerebrovascular
diseases
Malignant
neoplasms
Influenza and
pneumonia
Alzheimer's
disease
Diabetes mellitus
Chronic lower
respiratory diseases
Hypertension
Nephritis
Unintentional
injuries
Septicemia
Pneumonitis
Parkinson's disease
Atherosclerosis
Aortic aneurysm
Benign neoplasms
Anemias
Nutritional
deficiencies
Peptic ulcer
Liver disease
American
Indian
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Influenza and
pneumonia
Diabetes mellitus
Chronic lower
respiratory diseases
Nephritis
Unintentional
injuries
Septicemia
Hypertension
Pneumonitis
Atherosclerosis
Parkinson's disease
5Benign neoplasms
5Nutritional
deficiencies
Gallbladder
disorders
Liver disease
5Anemias
5 Aortic aneurysm
Hispanic
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Influenza and
pneumonia
Diabetes mellitus
Chronic lower
respiratory diseases
Hypertension
Nephritis
Unintentional
injuries
Septicemia
Pneumonitis
Atherosclerosis
Parkinson's disease
Benign neoplasms
Gallbladder
disorders
Anemias
Aortic aneurysm
Liver disease
Nutritional
deficiencies
'For American Indian men, Septicemia and Alzheimer's disease tied for 9th; Aortic aneurysm, Atherosclerosis, and Gallbladder disorders tied
for 15th; and Anemias, Liver disease, and Nutritional deficiencies tied for 19th.
2For Hispanic men, Septicemia and Hypertension tied for 10th; and Gallbladder disorders and Suicide tied for 19th.
3For Asian or Pacific Islander men, Nutritional deficiencies and Tuberculosis tied for 19th.
4For all men, Gallbladder disorders and Liver disease tied for 20th.
5For American Indian women, Benign neoplasms and Nutritional deficiencies tied for 15th; and Anemias and Aortic aneurysm tied for 19th.
Note: See Appendix B for the definition of race and Hispanic origin in the National Vital Statistics System.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
-------
Chronic Health Conditions
Table 16a. Percentage of people age 65 and over who reported having selected chronic
health conditions, by sex, 2005-2006
Heart
disease
Hyper-
tension
Stroke
Asthma
Chronic
bronchitis or
Emphysema
Any
cancer
Diabetes
Arthritis
Percent
Total
Men
Women
30.9
36.8
26.4
53.3
52.0
54.3
9.3
10.4
8.4
10.6
9.5
11.5
10.0
10.6
9.5
21.1
23.6
19.3
18.0
19.1
17.3
49.5
43.1
54.4
White, not Hispanic
or Latino 32.1 51.3 8.9 10.5 10.7 23.4 16.0 50.4
Black, not Hispanic
or Latino 26.2 70.4 15.6 12.3 6.0 11.5 28.8 55.1
Hispanic or Latino 22.2 53.8 6.5 9.0 6.4 12.1 25.3 39.7
Note: Data are based on a 2-year average from 2005-2006. See Appendix B for the definition of race and Hispanic origin in the National
Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 16b. Percentage of people age 65 and over who reported having selected chronic
health conditions, 1997-2006
1997-1998
1 999-2000
2001-2002
2003-2004
2005-2006
Heart
disease
32.3
29.8
31.5
31.8
30.9
Hyper-
tension
46.5
47.4
50.2
51.9
53.3
Stroke
8.2
8.2
8.9
9.3
9.3
Emphy-
sema
5.2
5.2
5.0
5.2
5.7
Asthma
Percent
7.7
7.4
8.3
8.9
10.6
Chronic Any
bronchitis cancer
6.4
6.2
6.1
6.0
6.1
18.7
19.9
20.8
20.7
21.1
Diabetes
13.0
13.7
15.4
16.9
18.0
Arthritis
na
na
na
50.0
49.5
na Comparable data for arthritis not available prior to 2003-2004.
Note: Data are based on 2-year averages.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
-------
INDICATOR 17
Sensory Impairments and Oral Health
Table 17a. Percentage of people age 65 and over who reported having any trouble
hearing, any trouble seeing, or no natural teeth, by selected characteristics, 2006
Sex Age and poverty status Any trouble hearing Any trouble seeing No natural teeth
Percent
Both sexes
Men
Women
65 and over
65-74
75-84
85 and over
Below poverty
Above poverty
65 and over
65-74
75-84
85 and over
65 and over
65-74
75-84
85 and over
40.5
31.9
46.3
61.8
36.6
42.1
47.7
40.8
54.6
66.3
35.1
24.3
40.3
59.8
17.4
13.6
20.0
26.5
26.0
16.4
16.1
11.9
19.4
30.7
18.4
15.1
20.4
24.6
25.9
22.8
28.5
32.0
39.4
25.9
26.8
22.8
32.7
30.6
25.1
22.7
25.5
32.6
Note: Respondents were asked "Which statement best describes your hearing without a hearing aid: good, a little trouble,
a lot of trouble, deaf?" For the purposes of this indicator the category "Any trouble hearing" includes "a little trouble, a lot
of trouble, and deaf." Regarding their vision, respondents were asked "Do you have any trouble seeing, even when wearing
glasses or contact lenses?" and the category "Any trouble seeing" includes those who in a subsequent question report
themselves as blind. Lastly, respondents were asked, in one question, "Have you lost all of your upper and lower natural
(permanent) teeth?"
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 17b. Percentage of people age 65 and over who reported
ever having worn a hearing aid, 2006
Age group
65 and over
65-74
75-84
85 and over
Both sexes
13.3
7.5
17.0
28.6
Men
Percent
18.0
11.0
24.2
40.4
Women
9.8
4.5
11.7
23.3
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics,
National Health Interview Survey.
-------
INDICATOR 18
Respondent-Assessed Health Status
Table 18. Respondent-assessed health status among people age 65
selected characteristics, 2004-2006
Selected
characteristic
Fair or poor health
Both sexes
65 and over
65-74
75-84
85 and over
Men
65 and over
65-74
75-84
85 and over
Women
65 and over
65-74
75-84
85 and over
Good to excellent health
Both sexes
65 and over
65-74
75-84
85 and over
Men
65 and over
65-74
75-84
85 and over
Women
65 and over
65-74
75-84
85 and over
Not Hispanic or Latino
Total
26.0
22.5
28.6
34.2
25.7
22.1
28.8
36.8
26.3
22.9
28.5
32.9
74.0
77.5
71.4
65.8
74.3
77.9
71.2
63.2
73.7
77.1
71.5
67.1
White only
23.7
19.9
26.1
32.6
23.8
20.0
26.9
35.1
23.6
19.8
25.6
31.3
76.3
80.1
73.9
67.4
76.2
80.0
73.1
64.9
76.4
80.2
74.4
68.7
Black only
Percent
39.7
36.7
43.5
45.7
37.3
34.7
41.1
45.4
41.3
38.2
44.9
45.8
60.3
63.3
56.5
54.3
62.7
65.3
58.9
54.6
58.7
61.8
55.1
54.2
and over, by
Hispanic or Latino
(of any race)
37.1
32.4
43.2
52.9
35.6
31.0
40.6
65.0
38.2
33.6
44.9
62.9
67.6
56.8
47.1
64.4
69.0
59.4
35.0
61.8
66.4
55.1
53.2
Note: Data are based on a 3-year average from 2004-2006. See Appendix B for the definition of race and Hispanic origin in the
National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
-------
INDICATOR 19
Depressive Symptoms
Table 19a. Percentage of people age 65 and over with clinically relevant
depressive symptoms, by sex, selected years 1998-2004
1998
2000
2002
2004
Both sexes
Men
Women
15.9
11.9
18.6
15.6
11.4
18.5
15.4
11.5
18.0
14.4
11.0
16.8
Note: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive
symptoms from an abbreviated version of theCenterfor Epidemiological Studies Depression Scale (CES-D) adapted by the
Health and Retirement Study (MRS). The CES-D scale is a measure of depressive symptoms and is not to be used as a diagnosis
of clinical depression. A detailed explanation concerning the "4 or more symptoms" cut-off can be found in the following
documentation: hrsonline.isr.umich.edu/docs/userg/dr-005.pdf. Proportions are based on weighted data using the preliminary
respondent weight from MRS 2004.
Reference population:These data refer to the civilian noninstitutionalized population.
Source: Health and Retirement Study.
Table 19b. Percentage of people age 65 and over with clinically relevant
depressive symptoms, by age group and sex, 2004
Both sexes
Men
Women
65 and over
65-74
75-84
85 and over
14.4
13.1
14.8
19.2
11.0
9.7
10.6
19.2
16.8
15.6
17.7
19.2
Note: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive
symptoms from an abbreviated version of theCenterfor Epidemiological Studies Depression Scale (CES-D) adapted by the
Health and Retirement Study (HRS). The CES-D scale is a measure of depressive symptoms and is not to be used as a diagnosis
of clinical depression. A detailed explanation concerning the "4 or more symptoms" cut-off can be found in the following
documentation: hrsonline.isr.umich.edu/docs/userg/dr-005.pdf. Proportions are based on weighted data using the preliminary
respondent weight from HRS 2004.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Health and Retirement Study.
-------
INDICATOR 20
Functional Limitations
Table 20a. Percentage of Medicare enrollees age 65 and over who have limitations in
activities of daily living (ADLs) or instrumental activities of daily living (lADLs), or who
are in a facility, selected years 1992-2005
lADLsonly
1 to 2 ADLs
3 to 4 ADLs
5 to 6 ADLs
Facility
Total
1992
13.7
19.6
6.1
3.5
5.9
48.8
1997
12.7
16.6
4.9
3.2
5.1
42.5
200?
13.4
17.2
5.3
3.0
4.8
43.7
2005
12.3
18.3
4.7
2.5
4.3
42.1
Note: The Medicare Current Beneficiary Survey has replaced the National Long Term Care Survey as the data source for this indicator.
Consequently, the measurement of functional limitations (previously called disability) has changed from previous editions of Older
Americans. A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds and is licensed
as a nursing home or other long term care facility and provides at least one personal care service; or provides 24-hour, 7-day-a-week
supervision by a caregiver. ADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of
the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. IADL limitations refer to difficulty
performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy
housework, meal preparation, shopping, or managing money. Rates are age adjusted using the 2000 standard population.
Reference: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 20
Functional Limitations continued
Table 20b. Percentage of Medicare enrollees age 65 and
over who are unable to perform certain physical functions,
by sex, 1991 and 2005
Function
1991
2005
Men
Stoop/kneel
Reach over head
Write
Walk 2-3 blocks
LifMOIbs.
Any of these five
Women
Stoop/kneel
Reach over head
Write
Walk 2-3 blocks
LifMOIbs.
Any of these five
Percent
7.8
3.1
2.2
14.0
9.1
18.9
15.2
6.2
2.6
23.0
18.3
32.1
9.9
2.6
1.3
14.6
7.7
19.0
18.1
5.1
2.3
22.9
15.5
31.9
Note: Rates for 1991 are age adjusted to the 2005 population.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 20c. Percentage of Medicare enrollees age 65
and over who are unable to perform any one of five
physical functions, by selected characteristics, 2005
Selected characteristic
Men
Women
65-74
75-84
85 and over
White, not Hispanic or Latino
Black, not Hispanic or Latino
Hispanic or Latino (of any race)
13.5
22.1
38.3
18.6
24.0
20.7
Percent
21.7
34.3
55.9
31.7
34.8
32.5
Note: The five physical functions include stooping/kneeling, reaching over the
head, writing, walking 2-3 blocks, and lifting 10 Ibs. See Appendix B for the definition
of race and Hispanic origin in the Medicare Current Beneficiary Survey.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 21
Vaccinations
Table 21 a. Percentage of people age 65 and over who reported having been vaccinated
against influenza and pneumococcal disease, by race and Hispanic origin, selected years
1989-2006
Influenza
Not Hispanic or Latino
Year
1989
1991
1993
1994
1995
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
White
32.0
42.8
53.1
56.9
60.0
65.8
65.6
67.9
66.6
65.4
68.7
68.6
67.3
63.2
67.3
Black
17.7
26.5
31.1
37.7
39.5
44.6
45.9
49.7
47.9
47.9
49.5
47.8
45.7
39.6
47.1
Pneumococcal disease
Hispanic
or Latino
(of any race)
23.8
33.2
46.2
36.6
49.5
52.7
50.3
55.1
55.7
51.9
48.5
45.4
54.6
41.7
44.9
Not Hispanic or Latino
White
15.0
21.0
28.7
30.5
34.2
45.6
49.5
53.1
56.8
57.8
60.3
59.6
60.9
60.6
62.0
Black
6.2
13.2
13.1
13.9
20.5
22.2
26.0
32.3
30.5
33.9
36.9
37.0
38.6
40.4
35.6
Hispanic
or Latino
(of any race)
9.8
11.0
12.2
13.7
21.6
23.5
22.8
27.9
30.4
32.9
27.1
31.0
33.7
27.5
33.4
Note: For influenza, the percentage vaccinated consists of people who reported having a flu shot during the past 12 months and does
not include receipt of nasal spray flu vaccinations. For pneumococcal disease, the percentage refers to people who reported ever having
a pneumonia vaccination. See Appendix B for the definition of race and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 21 b. Percentage of people age 65 and over who reported
having been vaccinated against influenza and pneumococcal
disease, by selected characteristics, 2006
Selected characteristic
Influenza
Pneumococcal disease
Percent
Both sexes
Men
Women
65-74
75-84
85 and over
High school graduate or less
More than high school
64.2
64.7
63.8
60.3
68.7
71.8
61.1
69.6
57.1
54.3
59.2
52.3
64.2
60.7
54.7
61.3
Note: For influenza, the percentage vaccinated consists of people who reported having a flu
shot during the past 12 months and does not include receipt of nasal spray flu vaccinations. For
pneumococcal disease, the percentage refers to people who reported ever having a pneumonia
vaccination.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National
Health Interview Survey.
-------
INDICATOR 22
Mammography
Table 22. Percentage of women who reported having had a mammogram within the past
2 years, by selected characteristics, selected years 1987-2005
Age groups
40-49
50-64
65 and over
65-74
75 and over
Race and Hispanic origin
White, not Hispanic or Latino
Black, not Hispanic or Latino
Hispanic or Latino (of any race)
Poverty
Below 1 00 percent
100-199 percent
200 percent or more
Education
No high school
diploma or GED
High school diploma or GED
Some college or more
1987
1990
7997
1993
1994
1998
7999
2000
2003
2005
Women age 40 and over
31.9
31.7
22.8
26.6
17.3
55.1
56.0
43.4
48.7
35.8
55.6
60.3
48.1
55.7
37.8
59.9
65.1
54.2
64.2
41.0
61.3
66.5
55.0
63.0
44.6
63.4
73.7
63.8
69.4
57.2
Women age 65 and
24.0
14.1
*
13.1
19.9
29.7
16.5
25.9
32.3
43.8
39.7
41.1
30.8
38.6
51.5
33.0
47.5
56.7
49.1
41.6
40.9
35.2
41.8
57.8
37.7
54.0
57.9
54.7
56.3
*35.7
41.7
47.0
64.3
44.2
57.4
64.8
54.9
61.0
48.0
43.2
47.9
64.9
45.6
59.1
64.3
64.3
60.6
59.0
51.9
57.8
70.1
54.7
66.8
71.3
67.2
76.5
66.8
73.9
58.9
over
66.8
68.1
67.2
57.6
60.2
72.5
56.6
68.4
77.1
64.3
78.7
67.9
74.0
61.3
68.3
65.5
68.3
54.8
60.3
75.0
57.4
71.8
74.1
64.4
76.2
67.7
74.6
60.6
68.1
65.4
69.5
57.0
62.8
72.6
56.9
69.7
75.1
63.5
71.8
63.8
72.5
54.7
64.7
60.5
63.8
52.3
56.2
70.1
50.7
64.3
73.0
"Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error (RSE) of 20-30 percent. Data not shown
have an RSE greater than 30 percent.
Note: Questions concerning use of mammography differed slightly on the National Health Interview Survey (NHIS) across the years for
which data are shown. In 1987 and 1990, women were asked to report when they had their last mammogram. In 1991, women were asked
whether they had a mammogram in the past 2 years. In 1993 and 1994, women were asked whether they had a mammogram within the
past year, between 1 and 2 years ago, or over 2 years ago. In 1998, women were asked whether they had a mammogram a year ago or
less, more than 1 year but not more than 2 years, or more than 2 years ago. In 1999, women were asked when they had their most recent
mammogram in days, weeks, months, or years. In 1999,10 percent of women in the sample responded "2 years ago,"and in this analysis,
these women were coded as "within the past 2 years" although a response of "2 years ago" may include women whose last mammogram
was more than 2 but less than 3 years ago. Thus, estimates for 1999 are overestimated to some degree in comparison with estimates in
previous years. In 2000 and 2003, women were asked when they had their most recent mammogram (give month and year). Women who
did not respond were given a followup question that used the 1999 wording, and women who did not answer the followup question
were asked a second followup question that used the 1998 wording. In 2000 and 2003,2 percent of women in the sample answered "2
years ago" using the 1999 wording, and they were coded as "within the past 2 years." Thus, estimates for 2000 and 2003 may be slightly
overestimated in comparison with estimates for years prior to 1999. In 2005, women were asked the same series of mammography
questions as in the 2000 and 2003 surveys, but the skip pattern was modified so that more women were asked the follow-up question
using the 1998 wording. Because additional information was available for women who replied their last mammogram was 2 years ago,
these women were not uniformly coded as having had a mammogram within the past 2 years. Thus, estimates for 2005 are more precise
compared with estimates for 1999,2000, and 2003 and are slightly lower than they would have been without this additional information.
See Appendix B for the definition of race and Hispanic origin in the NHIS.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
-------
INDICATOR 23
Diet Quality
Table 23. Healthy Eating lndex-2005 (HEI-2005) total and component scores for
people age 55 and over, by age group, 2001-2002
HEI-2005 Component
(Maximum Score)
Total fruit (5)
Whole fruit (5)
Total vegetables (5)
Dark green and orange
vegetables and legumes (5)
Total grains (5)
Whole grains (5)
Milk (10)
Meat and Beans (10)
Oils (10)
Saturated fat (10)
Sodium (10)
Calories from Solid Fat, Alcohol,
and Added Sugar (20)
Total HEI-2005 score (100)
Age group
55-64
3.6
5.0
4.0
1.7
5.0
1.4
5.4
10.0
7.8
6.5
3.9
9.7
64.0
65 and over
4.5
5.0
4.3
2.2
5.0
1.9
5.8
10.0
7.5
7.1
3.2
11.2
67.7
65-74
4.5
5.0
4.4
2.3
5.0
1.8
5.5
10.0
7.8
7.2
3.4
11.1
68.0
75 and over
4.6
5.0
4.2
1.9
5.0
1.9
6.1
10.0
7.5
7.2
3.0
11.3
67.8
Note: Diet quality was measured using the Healthy Eating lndex-2005 (HEI-2005), which has 12 components. Each component
represents a different aspect of a healthful diet according to the 2005 Dietary Guidelines for Americans. A higher score for each
component represents a healthier diet. Dietary adequacy is addressed by Total Fruit; Whole Fruit (forms other than juice);Total
Vegetables; Dark Green and Orange Vegetables and Legumes (cooked dry beans and peas);Total Grains; Whole Grains; Milk (all
milk products and soy beverages); Meat and Beans (meat, poultry,fish, eggs, soybean products other than beverages, nuts,and
seeds);and Oils (nonhydrogenated vegetable oils and oils in fish, nuts,and seeds). For the remaining three components—Satur-
ated Fat;Sodium;and Calories from Solid Fat, Alcohol, and Added Sugar—higher scores reflect lower intakes.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination
Survey, 2001 -2002; U.S. Department of Agriculture, Center for Nutrition Policy and Promotion.
-------
INDICATOR 24
Physical Activity
Table 24a. Percentage of people age 45 and over who reported engaging in
regular leisure time physical activity, by age group, 1997-2006
65 and over
45-64
65-74
75-84
85 and over
1997-1998
1 999-2000
2001-2002
2003-2004
2005-2006
20.7
21.3
21.6
22.5
21.6
29.1
28.9
30.1
30.5
29.3
Percent
24.9
26.1
26.5
27.5
25.7
17.0
17.3
17.9
19.4
19.5
9.0
9.6
8.5
8.4
9.6
Note: Data are based on 2-year averages. "Regular leisure time physical activity" is defined as "engaging in light-moderate leisure
time physical activity for greater than or equal to 30 minutes at a frequency greater than or equal to 5 times per week, or engaging in
vigorous leisure time physical activity for greater than or equal to 20 minutes at a frequency greater than or equal to 3 times per week."
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 24b. Percentage of people age 65 and over who reported
engaging in regular leisure time physical activity, by selected
characteristics, 2005-2006
Total Men Women
All 21.5 24.6 19.2
White, not Hispanic or Latino 22.7 25.8 20.4
Black, not Hispanic or Latino 13.5 17.7 10.4
Hispanic or Latino (of any race) 15.8 16.9 14.7
Percent who engage in strengthening exercises 12.7 13.8 12.0
Note: Data are based on a 2-year average from 2005-2006. "Regular leisure time physical activity"
is defined as "engaging in light-moderate leisure time physical activity for greater than or equal to
30 minutes at a frequency greater than or equal to 5 times per week, or engaging in vigorous leisure
time physical activity for greater than or equal to 20 minutes at a frequency greater than or equal
to 3 times per week." See Appendix B for the definition of race and Hispanic origin in the National
Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National
Health Interview Survey.
-------
INDICATOR 25
Obesity
Table 25. Body weight status among people age 65 and over, by sex and age group,
selected years 1976-2006
Sex and age group
1976-1980
1988-1994
1 999-2000
2001-2002
2003-2004
2005-2006
Percent
Overweight
Both sexes
65 and over
65-74
75 and over
Men
65 and over
65-74
75 and over
Women
65 and over
65-74
75 and over
Obese
Both sexes
65 and over
65-74
75 and over
Men
65 and over
65-74
75 and over
Women
65 and over
65-74
75 and over
na
57.2
na
na
54.2
na
na
59.5
na
na
17.9
na
na
13.2
na
na
21.5
na
60.1
64.1
53.9
64.4
68.5
56.5
56.9
60.3
52.3
22.2
25.6
17.0
20.3
24.1
13.2
23.6
26.9
19.2
69.0
73.5
62.3
73.3
77.2
66.4
65.6
70.1
59.6
31.0
36.3
23.2
28.7
33.4
20.4
32.9
38.8
25.1
69.1
73.1
63.5
73.1
75.4
69.2
66.3
71.3
60.1
29.2
35.9
19.8
25.3
30.8
16.0
32.1
40.1
22.1
70.5
74.0
65.9
72.1
76.6
65.2
69.2
71.7
66.4
29.7
34.6
23.5
28.9
33.0
22.7
30.4
36.1
24.1
68.6
73.8
61.8
73.9
79.5
66.3
64.6
69.4
58.7
30.5
35.0
24.7
29.7
32.9
25.3
31.1
36.7
24.4
na Data not available.
Note: Data are based on measured height and weight. Height was measured without shoes. Overweight is defined as having a body mass
index (BMI) greater than or equal to 25 kilograms/meter2. Obese is defined by a BMI of 30 kilograms/meter2or greater. The percentage of
people who are obese is a subset of the percentage of those who are overweight. See Appendix C for the definition of BMI.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.
-------
INDICATOR 26
Cigarette Smoking
Table 26a. Percentage of people age 45 and over who are current cigarette smokers,
by selected characteristics, selected years 1965-2007*
Total
Year
Men
1965
1974
1979
1983
1985
1987
1988
1990
1991
1992
1993
1994
1995
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007*
Women
1965
1974
1979
1983
1985
1987
1988
1990
1991
1992
1993
1994
1995
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007*
45-64
51.9
42.6
39.3
35.9
33.4
33.5
31.3
29.3
29.3
28.6
29.2
28.3
27.1
27.6
27.7
25.8
26.4
26.4
24.5
23.9
25.0
25.2
24.5
22.6
32.0
33.4
30.7
31.0
29.9
28.6
27.7
24.8
24.6
26.1
23.0
22.8
24.0
21.5
22.5
21.0
21.7
21.4
21.1
20.2
19.8
18.8
19.3
20.0
65 and over
28.5
24.8
20.9
22.0
19.6
17.2
18.0
14.6
15.1
16.1
13.5
13.2
14.9
12.8
10.4
10.5
10.2
11.5
10.1
10.1
9.8
8.9
12.6
8.6
9.6
12.0
13.2
13.1
13.5
13.7
12.8
11.5
12.0
12.4
10.5
11.1
11.5
11.5
11.2
10.7
9.3
tg.1
8.6
8.3
8.1
8.3
8.3
8.1
45-64
51.3
41.2
38.3
35.0
32.1
32.4
30.0
28.7
28.0
28.1
27.8
26.9
26.3
26.5
27.0
24.5
25.8
25.1
24.4
23.3
24.4
24.5
23.4
21.5
32.7
33.0
30.6
30.6
29.7
29.0
27.7
25.4
25.3
25.8
23.4
23.2
24.3
20.9
22.5
21.2
21.4
21.6
21.5
20.1
20.1
18.9
18.8
21.2
White
65 and over
Percent
27.7
24.3
20.5
20.6
18.9
16.0
16.9
13.7
14.2
14.9
12.5
11.9
14.1
11.5
10.0
10.0
9.8
10.7
9.3
9.6
9.4
7.9
12.6
8.6
9.8
12.3
13.8
13.2
13.3
13.9
12.6
11.5
12.1
12.6
10.5
11.1
11.7
11.7
11.2
10.5
9.1
9.4
8.5
8.4
8.2
8.4
8.4
8.6
Black or African American
45-64
57.9
57.8
50.0
44.8
46.1
44.3
43.2
36.7
42.0
35.4
42.4
41.2
33.9
39.4
37.3
35.7
32.2
34.3
29.8
30.1
29.2
32.4
32.6
30.5
25.7
38.9
34.2
36.3
33.4
28.4
29.5
22.6
23.4
30.9
21.3
23.5
27.5
28.4
25.4
22.3
25.6
22.6
22.2
23.3
20.9
21.0
25.5
21.0
65 and over
36.4
29.7
26.2
38.9
27.7
30.3
29.8
21.5
24.3
28.3
*27.9
25.6
28.5
26.0
16.3
17.3
14.2
21.1
19.4
18.0
14.1
16.8
16.0
12.8
7.1
*8.9
*8.5
*13.1
14.5
11.7
14.8
11.1
9.6
*11.1
*10.2
13.6
13.3
10.7
11.5
13.5
10.2
9.3
9.4
8.0
6.7
10.0
9.3
8.2
* Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20-30 percent.
tjhe value for all women includes other races which have a very low rate of cigarette smoking. Thus, the weighted average for all women is
slightly lower than that for white women.
*The 2007 estimates are based on Early Release National Health Interview Survery (NHIS) data collected January-June 2007, using
preliminary weights.
Note: Data starting in 1997 are not strictly comparable with data for earlier years because of the 1997 NHIS questionnaire redesign. Starting
with 1993 data, current cigarette smokers were defined as ever smoking 100 cigarettes in their lifetime and now smoking everyday or some
days. See Appendix B for the definition of race and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
-------
1 INDICATOR 26
Table 26 b. Cigarette
and age group, 2006
Sex and age group
Both sexes
Men
18-44
45-64
65 and over
Women
18-44
45-64
65 and over
| Cigarette Smoking
smoking
All current
smokers
20.8
26.7
24.5
12.6
20.6
19.3
8.3
continued
status of people age 1 8 and over, by sex
Every day
smokers
16.7
20.0
21.1
10.4
15.9
16.5
7.0
Some day
smokers
Percent
4.2
6.6
3.5
2.2
4.7
2.8
1.3
Former
smokers
21.0
12.1
32.1
51.1
11.3
22.0
27.9
Non-
smokers
58.2
61.3
43.4
36.2
68.2
58.7
63.8
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
INDICATOR 27
Air Quality
Table 27a. Percentage of people age 65 and over living in counties with "poor air quality,"
2000-2006
Pollutant measures
2000
2001
2002
2003
2004
2005
2006
Particulate matter (PM 2.5) 44.0 37.3 35.7
8hr Ozone 31.0 37.1 46.7
Any standard 55.4 51.1 53.3
Percent
32.2
32.5
44.8
23.8
11.7
28.5
35.0
32.1
46.6
21.2
24.2
33.8
Note: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards
(NAAQS). The term "any standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon
monoxide, and lead. Data for previous years has been computed using the new daily PM 2.5 standard of 35 micrograms/m3 to enable
comparisons across time. This results in percentages that are not comparable to previous publications.
Reference population: These data refer to the resident population.
Source: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau,
Population Projections, 2000-2006.
-------
Air Quality continued
Table 27b. Counties with "poor air quality"for any standard in 2006
State
Alabama
Alabama
Alabama
Alaska
Arizona
Arizona
Arizona
Arkansas
Arkansas
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
Colorado
Colorado
Colorado
Colorado
Connecticut
Connecticut
Connecticut
Connecticut
Connecticut
Connecticut
Connecticut
Delaware
District of Columbia
Georgia
Georgia
Georgia
County
Mobile
Russell
Shelby
Matanuska-Susitna
Maricopa
Pinal
Santa Cruz
Crittenden
Pulaski
Alameda
Amador
Butte
Calaveras
Contra Costa
El Dorado
Fresno
Imperial
Inyo
Kern
Kings
Los Angeles
Merced
Mono
Nevada
Orange
Placer
Riverside
Sacramento
San Bernardino
San Diego
San Joaquin
San LuisObispo
Santa Clara
Stanislaus
Sutler
Tehama
Tulare
Ventura
Yolo
Alamosa
Douglas
Jefferson
Larimer
Fairfield
Hartford
Litchfield
Middlesex
New Haven
New London
Tolland
Kent
District of Columbia
Bibb
Clarke
Clayton
State
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Illinois
Indiana
Indiana
Indiana
Kentucky
Kentucky
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Massachusetts
Massachusetts
Massachusetts
Massachusetts
Michigan
Michigan
Michigan
Michigan
Michigan
Mississippi
Missouri
Missouri
Missouri
Missouri
Missouri
Missouri
Montana
Montana
County
Cobb
Coweta
DeKalb
Douglas
Fayette
Floyd
Fulton
Gwinnett
Henry
Muscogee
Richmond
Rockdale
Washington
Wilkinson
Madison
Clark
Knox
Marion
Jefferson
McCracken
Ascension
Caddo
East Baton Rouge
Iberville
Jefferson
PointeCoupee
St. Bernard
West Baton Rouge
Anne Arundel
Baltimore
Baltimore City
Cecil
Charles
Frederick
Harford
Montgomery
Prince George's
Bristol
Dukes
Hampden
Hampshire
Allegan
Chippewa
Muskegon
St.Clair
Wayne
DeSoto
Clay
Clinton
Jasper
Jefferson
St. Charles
St. Louis City
Lincoln
Missoula
See footnotes at end of table.
-------
INDICATOR 27
Air Quality continued
Table 27b. Counties with "poor air quality"for any standard in 2006 (continued)
State
Montana
Nevada
Nevada
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Mexico
New Mexico
New Mexico
New York
New York
New York
New York
New York
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
Ohio
Ohio
Ohio
Ohio
Oklahoma
Oklahoma
Oklahoma
Oklahoma
Oklahoma
Oregon
Oregon
Oregon
Oregon
Oregon
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
County
Silver Bow
Clark
Nye
Bergen
Camden
Essex
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
Ocean
Union
Bernalillo
Dona Ana
Sandoval
Bronx
Kings
New York
Richmond
Suffolk
Catawba
Davidson
Guilford
Mecklenburg
Rowan
Wake
Ashtabula
Cuyahoga
Hamilton
Warren
Creek
Jefferson
Kay
Love
Oklahoma
Douglas
Klamath
Lane
Multnomah
Washington
Allegheny
Beaver
Berks
Bucks
Cambria
Chester
State
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
South Carolina
South Carolina
South Carolina
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Utah
Utah
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Washington
Washington
West Virginia
West Virginia
West Virginia
Wisconsin
Wisconsin
Wisconsin
Wyoming
County
Dauphin
Delaware
Lancaster
Montgomery
Northampton
Philadelphia
Washington
Greenville
Lexington
Spartanburg
Blount
Dyer
Hamilton
Knox
Montgomery
Sevier
Shelby
Sumner
Bexar
Brazoria
Collin
Dallas
Denton
El Paso
Harris
Hood
Jefferson
Montgomery
Parker
Tarrant
Webb
Cache
Salt Lake
Arlington
Caroline
Fairfax
Henrico
Prince William
Stafford
King
Pierce
Brooke
Hancock
Kanawha
Brown
Milwaukee
Outagamie
Sweetwater
Note: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient
Air Quality Standards (NAAQS).The term "any standard" refers to any NAAQS for ozone, particulate matter, nitrogen
dioxide, sulfur dioxide, carbon monoxide, and lead.
Reference population: These data refer to the resident population.
Source: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System;
U.S. Census Bureau, Population Projections, 2000-2006.
-------
INDICATOR 28
Use of Time
Table 28a. Percentage of day that people age 55 and over spent doing selected activities
on an average day, by age group, 2006
55-64
Selected activities
Sleeping
Leisure activities
Work and work-related activities
Household activities
Caring for and helping others
Eating and drinking
Purchasing goods and services
Grooming
Other activities
Average
hours per day
8.4
5.4
3.8
2.1
0.4
1.3
0.9
0.7
1.0
Percent
of day
35.0
22.6
15.8
8.8
1.9
5.5
3.8
2.7
4.0
65-74
Average
hours per day
8.9
7.0
0.9
2.6
0.4
1.4
0.9
0.6
1.2
Percent
of day
36.9
29.1
3.9
11.0
1.8
6.0
3.9
2.7
4.8
75 and over
Average
hours per day
9.0
7.8
0.3
2.3
0.3
1.5
0.8
0.7
1.3
Percent
of day
37.4
32.6
1.4
9.7
1.4
6.2
3.3
2.7
5.3
Note: "Other activities" includes activities such as educational activities; organizational, civic, and religious activities; and telephone calls.
Table includes people who did not work at all.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Bureau of Labor Statistics, American Time Use Survey.
Table 28b. Percentage of total leisure time that people age 55 and over spent doing
selected leisure activities on an average day, by age group, 2006
55-64
Selected leisure
activities
Socializing and communicating
Watching TV
Participation in sports,
exercise, and recreation
Relaxing and thinking
Reading
Other leisure activities
(including related travel)
Average
hours per day
0.7
2.9
0.2
0.4
0.6
0.7
Percent
of day
13.1
53.4
4.1
6.6
10.1
12.7
65-74
Average
hours per day
0.8
3.8
0.3
0.5
0.8
0.8
Percent
of day
11.1
55.1
3.5
7.4
10.9
11.9
75 and over
Average
hours per day
0.8
4.2
0.2
0.9
1.1
0.8
Percent
of day
9.7
53.6
2.3
10.9
13.9
9.7
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Bureau of Labor Statistics, American Time Use Survey.
-------
INDICATOR 29
Use of Health Care Services
Table 29a. Use of Medicare-covered health care services by Medicare enrollees age 65 and
over, 1992-2005
Utilization measure
Year
Hospital stays
Skilled nursing
facility stays
Physician visits
and consultations
Home health
care visits
Rate per thousand
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
306
300
331
336
341
351
354
365
361
364
361
359
353
350
28
33
43
50
59
67
69
67
67
69
72
74
75
79
11,359
11,600
1 2,045
1 2,372
1 2,478
na
13,061
na
1 3,346
1 3,685
1 3,863
13,519
1 3,776
13,914
3,822
4,648
6,352
7,608
8,376
8,227
5,058
3,708
2,913
2,295
2,358
2,440
2,594
2,770
Average length
of hospital stay
Days
8.4
8.0
7.5
7.0
6.6
6.3
6.1
6.0
6.0
5.9
5.9
5.8
5.7
5.7
na Data not available.
Note: Data are for Medicare enrollees in fee-for-service only. Physician visits and consultations include all settings, such as physician offices,
hospitals, emergency rooms, and nursing homes. The definition of physician visits and consultations changed beginning in 2003, resulting
in a slightly lower rate. Beginning in 1994, managed care enrollees were excluded from the denominator of all utilization rates because
utilization data are not available for them. Prior to 1994, managed care enrollees were included in the denominators; they comprised 7
percent or less of the Medicare population.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
Table 29b. Use of Medicare-covered home health and skilled nursing facility
services by Medicare enrollees age 65 and over, by age group, 2005
Utilization measure
Skilled nursing facility stays
Home health care visits
65-74
30
1,333
75-84
Rate per thousand
92
3,407
85 and over
228
6,549
Note: Data are for Medicare enrollees in fee-for-service only.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
-------
INDICATOR 30
Health Care Expenditures
Table 30a. Average annual health care costs for Medicare enrollees
age 65 and over, in 2004 dollars, by age group, 1992-2004
Age
Year
Total
65-74
75-84
85 and over
Dollars
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
$8,644
9,262
9,984
10,444
10,560
10,796
10,538
10,831
1 1 ,243
1 1 ,865
12,735
1 2,846
13,052
$6,432
6,719
7,377
7,599
7,644
7,627
7,372
8,222
8,373
9,021
9,816
9,728
9,702
$9,459
10,587
11,058
11,429
11,887
11,993
11,723
11,485
1 2,256
13,194
1 3,830
14,357
14,214
$16,718
1 7,327
18,711
1 9,756
1 9,336
19,561
1 9,688
1 9,020
1 9,384
1 9,795
20,645
20,186
21,907
Note: Data include both out-of-pocket costs and costs covered by insurance. Dollars are inflation adjusted to 2004 using
the Consumer Price Index (Series CPI-U-RS).
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 30b. Major components of health care costs among Medicare enrollees age 65
and over, 1992 and 2004
1992
2004
Cost component
Average cost in dollars Percent Average cost in dollars Percent
Total
Inpatient hospital
Physician/Outpatient hospital
Long-term care facility
Home health care
Prescription drugs
Other (Short-term institution/Hospice/Dental)
$6,551
2,107
2,071
1,325
244
522
282
100
32
32
20
4
8
4
$13,052
3,217
4,565
1,842
380
1,987
1,061
100
25
35
14
3
15
8
Note: Data include both out-of-pocket costs and costs covered by insurance. Dollars are not inflation adjusted.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 30
Health Care Expenditures continued
Table 30c. Average annual health care costs among Medicare enrollees age 65 and over,
by selected characteristics, 2004
Selected characteristic
Average cost in dollars
Total
Race and ethnicity
White, not Hispanic or Latino
Black, not Hispanic or Latino
Hispanic or Latino (of any race)
Other
Institutional status
Community
Institution
Annual income
$0-$ 10,000
10,001-20,000
20,001-30,000
30,001 or more
Chronic conditions
0
1-2
3-4
5 or more
Veteran status (men only)
Yes
No
$13,052
13,101
14,989
11,962
10,601
10,448
52,958
1 6,766
13,558
1 2,985
10,676
4,718
8,489
14,907
20,334
1 2,280
13,138
Note: Data include both out-of-pocket costs and costs covered by insurance. Annual income includes that of respondent and spouse.
Chronic conditions include cancer (other than skin cancer), stroke, diabetes, heart disease, hypertension, arthritis, and respiratory
conditions (emphysema, asthma, chronic obstructive pulmonary disease). See Appendix B for the definition of race and Hispanic origin
in the Medicare Current Beneficiary Survey.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 30d. Major components of health care costs among Medicare enrollees
age 65 and over, by age group, 2004
Cost component
Total
Inpatient hospital
Physician/Outpatient hospital
Long-term care facility
Home health care
Prescription drugs
Other (Short-term institution/Hospice/Dental)
65-74
$9,702
2,365
4,172
431
158
1,958
618
75-84
Average cost in
$14,214
3,576
5,074
1,774
507
2,140
1,142
85 and over
dollars
$21,907
5,311
4,592
7,057
854
1,663
2,429
Note: Data include both out-of-pocket costs and costs covered by insurance.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 30
Health Care Expenditures continued
Table 30e. Percentage of Medicare enrollees age 65 and over who reported problems
with access to health care, 1992-2003
Reported problem 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Percent
Difficulty obtaining care 3.1 2.6 2.6 2.6 2.3 2.4 2.4 2.8 2.9 2.8 2.5 2.3
Delayed getting care
due to cost 9.8 9.1 7.6 6.8 5.5 4.8 4.4 4.7 4.8 5.1 6.1 5.3
Reference population: These data refer to noninstitutionalized Medicare enrollees.
Source: Medicare Current Beneficiary Survey (MCBS) Project. (December 2006). Health and Health Care of the Medicare Population: Data
from the 2003 MCBS. Rockville, MD: Westat.
INDICATOR 31
Prescription Drugs
Table 31 a. Average annual prescription drug costs and sources of payment among
noninstitutionalized Medicare enrollees age 65 and over, 1992-2004
Payment source 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Average cost in dollars
Total $570 $756 $802 $841 $907 $991 $1,147 $1,284 $1,469 $1,647 $1,827 $1,963 $2,107
Out-of-pocket 343 439 436 441 451 491 530 565 616 658 721 736 763
Private insurance 145 190 220 248 302 323 401 449 512 573 666 747 810
Public programs 82 127 146 152 155 177 215 270 341 416 441 480 534
Note: Dollars have been inflation adjusted to 2004 using the Consumer Price Index (CPI-U-RS). Reported costs have been adjusted by
a factor of 1.205 to account for underreporting of prescription drug use. Public programs include Medicare, Medicaid, Department of
Veterans Affairs, and other State and Federal programs.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 31 b. Distribution of annual prescription drug costs among noninstitutionalized
Medicare enrollees age 65 and over, 2004
Cost in dollars
Percent
Total
$0
1-499
500-999
1,000-1,499
1,500-1,999
2,000-2,499
2,500 or more
100.0
7.8
20.0
16.3
12.8
11.0
8.2
23.9
Note: Reported costs have been adjusted by a factor of 1.205 to account for underreporting of
prescription drug use.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 31
Prescription Drugs continued
Table 31 c. Number of Medicare enrollees age 65 and over who enrolled in
Part D prescription drug plans or who were claimed for Retiree Drug Subsidy
payments, June 2006 and September 2007
Part D benefit categories
All Medicare enrollees age 65 and over
Enrollees in prescription drug plans
Type of plan
Stand-alone plan
Medicare Advantage plan
Low income subsidy
Yes
No
Retiree Drug Subsidy
Other
June 2006
36,052,991
18,245,980
1 2,583,676
5,662,304
5,935,532
12,310,448
6,498,163
11,308,848
September 2007
36,91 7,978
19,747,718
13,171,983
6,575,735
5,906,610
13,841,108
6,454,729
10,715,531
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Management Information Integrated Repository.
Table 31 d. Average prescription drug costs among noninstitutionalized Medicare
enrollees age 65 and over, by selected characteristics, 2000,2002, and 2004
Characteristic
Number of chronic conditions
0
1-2
3-4
5 or more
Income
Less than $10,001
$10,001 -$20,000
$20,001 -$30,000
More than $30,000
2000
$ 551
1,153
2,030
2,772
1,383
1,402
1,571
1,520
2002
Average cost in dollars
$ 650
1,417
2,459
3,502
1,838
1,749
1,892
1,850
2004
$ 800
1,741
2,845
3,862
1,938
2,080
2,138
2,189
Note: Dollars have been inflation adjusted to 2004 using the Consumer Price Index (Series CPI-U-RS). Reported costs have been
adjusted by a factor of 1.205 to account for underreporting of prescription drug use. Chronic conditions include cancer (other than
skin cancer), stroke, diabetes, heart disease, hypertension, arthritis, and respiratory conditions (emphysema/asthma/chronic obstructive
pulmonary disease). Annual income includes that of respondent and spouse.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 32
Sources of Health Insurance
Table 32a. Percentage of noninstitutionalized Medicare enrollees age 65 and over with
supplemental health insurance, by type of insurance, 1991-2005
Types of supplemental insurance
Private (employer or Private
Year union sponsored) (Medigap)*
HMO
Medicaid
Other public
No
supplement
Percent
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
40.7
41.0
40.8
40.3
39.1
37.8
37.6
37.0
35.8
35.9
36.0
36.1
36.1
36.6
36.1
44.8
45.0
45.3
45.2
44.3
38.6
35.8
33.9
33.2
33.5
34.5
37.5
34.3
33.7
34.6
6.3
5.9
7.7
9.1
10.9
13.8
16.6
18.6
20.5
20.4
18.0
15.5
14.8
15.6
15.5
8.0
9.0
9.4
9.9
10.1
9.5
9.4
9.6
9.7
9.9
10.6
10.7
11.6
11.3
11.8
4.0
5.3
5.8
5.5
5.0
4.8
4.7
4.8
5.1
4.9
5.4
5.5
5.7
5.2
5.6
11.3
10.4
9.7
9.3
9.1
9.4
9.2
8.9
9.0
9.7
10.1
12.3
11.8
12.6
12.0
* Includes people with private supplement of unknown sponsorship.
Note: HMO health plans include Heath Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and private fee-for-
service plans (PFFs). Not all types of plans were available in all years. Since 2003 these types of plans have been known collectively as
Medicare Advantage. Estimates are based on enrollees' insurance status in the fall of each year. Categories are not mutually exclusive,
(i.e., individuals may have more than one supplemental policy). Table excludes enrollees whose primary insurance is not Medicare
(approximately 1-2 percent of enrollees). Medicaid coverage was determined from both survey responses and Medicare administrative
records; this is a change in methodology from that used in Older Americans Update 2006 and produces different estimates for "Medicaid"
and "No supplement" categories.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 32
Sources of Health Insurance continued
Table 32b. Percentage of people age 55-64 with health insurance coverage, by type of
insurance and poverty status, 2006
Type of Insurance
Private
Medicaid
Medicare
Other coverage
Uninsured
Total
75.4
5.9
4.3
3.5
10.8
99 percent
or less
24.8
33.3
9.4
2.6
29.9
Poverty threshold
100- 199 percent
Percent
48.8
10.3
12.2
5.4
23.3
200 percent
or more
86.3
1.9
2.2
3.3
6.2
Note: Poverty status is based on family income and family size using the U.S. Census Bureau's poverty thresholds. Below poverty (99
percent or less) is defined as people living below the poverty threshold. People living above poverty are divided between those with
incomes between 100-199 percent of the poverty threshold and those with incomes of 200 percent or more of the poverty threshold. A
multiple imputation procedure was performed for the missing family income data (unknown poverty). A detailed description of the multiple
imputation procedure is available from www.cdc.gov/nchs/nhis.htm via the Imputed Income Files link under data year 2006. Classification
of health insurance is based on a hierarchy of mutually exclusive categories. People with more than one type of health insurance were
assigned to the first appropriate category in the hierarchy. The category "uninsured" includes people who had no coverage as well as those
who only had Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care.
Beginning in quarter 3 of 2004, two additional questions were added to the National Health Interview Survey insurance section to reduce
potential errors in reporting of Medicare and Medicaid status. People age 65 and over not reporting Medicare coverage were asked explicitly
about Medicare coverage, and people under age 65 with no reported coverage were asked explicitly about Medicaid coverage. For a further
discussion of the impact of these additional questions see: Cohen and Martinez.53
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
INDICATOR 33
Out-of-Pocket Health Care Expenditures
Table 33a. Percentage of people age 55 and over with out-of-pocket expenditures for
health care service use, by age group, selected years 1977-2004
Age group
1977
1987
1996
2000
200?
2002
2003
2004
Percent
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
83.3
81.9
81.6
82.6
83.4
83.8
80.8
88.6
84.0
83.9
84.3
87.9
90.0
88.6
92.4
89.6
89.5
89.7
91.8
92.9
93.9
93.6
90.2
89.4
92.4
93.3
93.5
95.2
94.7
90.4
90.2
91.1
94.1
95.6
94.6
94.4
90.9
90.7
91.3
94.4
94.6
93.8
94.7
90.4
89.6
92.7
93.7
95.7
95.8
95.5
90.0
89.5
91.6
95.1
95.8
96.3
Note: Out-of-pocket health care expenditures exclude personal spending for health insurance premium(s). Data for the 1987 survey have
been adjusted to permit comparability across years; for details see Zuvekasand Cohen.54
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.
-------
INDICATOR 33
Out-of-Pocket Health Care Expenditures continued
Table 33b. Out-of-pocket health care expenditures as a percentage of household
income, among people age 65 and over with out-of-pocket expenditures, by selected
characteristics, selected years 1977-2004
Selected characteristic
Total
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Income category
Poor/near poor
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Other
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Health status category
Poor or fair health
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Excel lent, very good, or good
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
1977
7.2
5.2
5.1
5.5
6.4
8.8
7.9
12.3
16.1
17.5
13.3
11.0
14.4
12.4
5.4
3.9
3.7
4.2
5.0
6.2
5.2
9.5
8.7
8.8
8.6
8.7
11.3
8.9
health
6.1
3.9
3.9
4.1
5.3
7.5
7.6
1987
8.8
5.8
5.7
5.9
7.2
11.0
12.0
15.8
18.1
19.8
14.0
13.7
19.0
14.7
7.0
3.7
3.4
4.6
5.9
8.4
10.9
11.0
8.5
9.0
7.6
10.0
12.4
12.2
7.1
4.6
4.5
4.9
5.4
9.7
11.8
1996
8.4
7.1
6.2
9.5
7.7
9.0
9.8
19.2
30.0
27.6
34.3
21.6
18.3
(B)
5.6
3.2
2.9
3.8
4.9
6.3
7.8
11.7
13.0
11.8
15.9
10.7
11.8
(B)
6.6
5.0
4.1
7.3
6.3
7.2
6.4
2000 200?
Percent
9.1
7.0
6.1
9.3
8.1
10.4
10.1
22.6
29.9
28.1
(B)
24.4
22.9
17.6
6.3
3.4
3.1
4.3
5.6
6.9
7.6
13.1
14.1
12.8
17.4
11.8
14.6
13.8
6.7
4.0
3.5
5.6
6.2
7.5
7.1
10.0
7.6
6.9
9.6
8.7
11.4
11.8
23.5
31.2
29.6
34.9
25.7
23.3
18.7
7.3
4.2
3.9
5.3
6.2
8.4
9.3
13.9
13.6
12.9
15.2
13.5
14.7
13.2
7.6
5.2
4.8
6.6
6.2
9.1
10.6
2002
10.8
7.1
6.6
8.5
9.5
11.9
12.7
27.6
27.1
26.5
28.5
27.7
28.4
25.7
7.2
4.1
3.8
5.0
6.4
8.2
7.9
14.6
13.3
12.8
14.7
14.4
15.2
13.5
8.4
4.6
4.4
5.6
7.1
9.6
11.9
2003
11.6
7.3
6.9
8.4
9.2
13.4
16.4
27.8
29.9
30.0
29.9
23.4
30.2
32.4
8.0
4.5
4.2
5.5
6.9
9.1
10.3
16.0
13.3
12.4
15.9
13.8
17.5
19.5
8.9
5.0
4.9
5.4
6.9
10.7
13.9
2004
11.6
7.5
7.1
8.8
10.7
11.8
14.9
29.3
30.0
29.6
30.9
29.0
29.4
30.0
8.1
4.1
4.0
4.8
7.4
8.2
11.1
15.2
13.8
13.5
14.7
14.3
15.4
17.9
9.4
5.0
4.5
6.4
8.9
9.3
12.8
(B) Base is not large enough to produce reliable results.
Note: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Including expenditures for out-
of-pocket premiums in the estimates of out-of-pocket spending would increase the percentage of household income spent on health care
in all years. People are classified into the "poor/near poor" income category if their household income is below 125 percent of the poverty
level; otherwise, people are classified into the "other" income category. The poverty level is calculated according to the U.S. Census Bureau
guidelines for the corresponding year. The ratio of a person's out-of-pocket expenditures to their household income was calculated based
on the person's per capita household income. For people who's ratio of out-of-pocket expenditures to income exceeded 100 percent, the
ratio was capped at 100 percent. For people with out-of-pocket expenditures and with zero income (or negative income), the ratio was
set at 100 percent. For people with no out-of-pocket expenditures, the ratio was set to zero. These methods differ from what was used in
Older Americans 2004, which excluded people with no out-of-pocket expenditures from the calculations (17 percent of the population age
65 and over in 1977, and 4.5 percent of the population age 65 and over in 2004). Data from the 1987 survey have been adjusted to permit
comparability across years; for details, see Zuvekas and Cohen.54
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.
-------
INDICATOR 33 1
Out-of-Pocket Health Care Expenditures continued
Table 33c. Distribution of total out-of-pocket health care expenditures among people age
65 and over, by type of health care services and age group, 2000-2004
Type of health care
service, by year
2000
Hospital care
Office-based medical
provider services
Dental services
Prescription drugs
Other health care
2001
Hospital care
Office-based medical
provider services
Dental services
Prescription drugs
Other health care
2002
Hospital care
Office-based medical
provider services
Dental services
Prescription drugs
Other health care
2003
Hospital care
Office-based medical
provider services
Dental services
Prescription drugs
Other health care
2004
Hospital care
Office-based medical
provider services
Dental services
Prescription drugs
Other health care
55-64
8.5
18.9
20.0
44.7
7.8
9.8
19.8
18.6
45.7
6.1
10.2
21.3
18.1
43.8
6.6
9.2
18.8
16.7
48.5
6.8
9.2
20.1
16.9
46.0
7.8
55-6?
7.5
19.8
21.3
44.0
7.5
9.4
19.9
20.0
44.3
6.4
9.2
21.6
18.3
43.5
7.4
8.8
18.3
16.7
49.0
7.3
10.1
18.7
18.5
45.0
7.7
62-64
*11.0
16.7
17.0
46.5
8.7
10.7
19.7
15.2
48.9
5.5
13.1
20.3
17.7
44.7
4.3
10.1
19.9
16.9
47.5
5.6
6.9
23.6
12.8
48.7
8.1
65 and
over
6.4
9.8
15.8
53.6
14.3
5.4
9.4
13.0
56.0
16.2
5.0
10.5
14.0
58.2
12.3
5.2
8.7
11.8
58.3
16.0
5.0
10.1
11.8
61.4
11.8
65-74
7.3
11.6
17.5
57.1
6.6
5.2
10.5
15.6
57.2
11.5
4.6
12.3
17.6
57.9
7.7
5.9
9.4
14.5
61.3
8.9
5.1
12.4
13.2
61.9
7.4
75-S4
4.6
9.0
15.9
51.5
19.0
5.8
9.6
11.9
58.9
13.8
5.5
9.3
12.3
56.6
16.3
4.5
9.1
9.5
54.5
22.4
4.5
9.2
12.0
64.8
9.5
85 and
over
8.6
6.0
9.6
48.0
27.9
M.8
6.0
8.3
45.1
*35.8
5.1
7.8
6.2
65.5
15.4
5.1
5.4
9.5
59.8
20.2
*5.9
5.3
7.5
51.9
29.5
* Indicates the relative standard error is greater than 30 percent.
Note: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Hospital care includes hospital
inpatient care and care provided in hospital outpatient departments and emergency rooms. Office-based medical provider services include
services provided by medical providers in nonhospital-based medical offices or clinic settings. Dental services include care provided by
any type of dental provider. Prescription drugs include prescribed medications purchased, including refills. Other health care includes care
provided by home health agencies and independent home health providers and expenses for eyewear, ambulance services, orthopedic
items, hearing devices, prostheses, bathroom aids, medical equipment, disposable supplies, and other miscellaneous services. The majority
of expenditures in the "other" category are for home health services and eyeglasses.
Reference population: These data refer to the civilian noninstitutionalized population.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey.
-------
INDICATOR 34
Sources of Payment for Health Care Services
Table 34a. Sources of payment for health care services for Medicare enrollees age 65
and over, by type of service, 2004
Service
Hospice
Inpatient hospital
Home health care
Short-term institution
Physician/Medical
Outpatient hospital
Prescription drugs
Dental
Long-term care facility
All
Average cost
per enrol lee
Dollars
$183
3,217
380
569
3,427
1,137
1,987
309
1,842
13,052
Total
100
100
100
100
100
100
100
100
100
100
Medicare
100
89
93
78
67
67
3
1
0
53
Medicaid
Percent
0
1
1
3
2
2
10
1
48
9
OOP
0
2
5
9
15
8
32
76
45
19
Other
0
7
2
9
16
24
55
22
6
19
Note: OOP refers to out-of-pocket payments. "Other" refers to private insurance, Department of Veterans Affairs, and other public
programs.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 34b. Sources of payment for health care services for Medicare enrollees age 65
and over, by income, 2004
Income
All
$0-$ 10,000
10,001-20,000
20,001-30,000
30,001 or more
Average cost
Dollars
$13,052
16,766
13,558
1 2,985
10,676
Total
100
100
100
100
100
Medicare
53
53
53
57
51
Medicaid
Percent
9
25
11
2
1
OOP
19
14
20
21
21
Other
19
8
17
21
27
Note: Income refers to annual income of respondent and spouse. OOP refers to out-of-pocket payments. "Other" refers to private insurance,
Department of Veterans Affairs, and other public programs.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
-------
INDICATOR 35
Veterans' Health Care
Table 35. Total number of veterans age 65 and over who are enrolled in or receiving
health care from the Veterans Health Administration, 1990-2006
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Total
7.9
8.3
8.7
9.0
9.2
9.4
9.7
9.8
9.9
10.0
10.0
9.9
9.8
9.7
9.5
9.3
9.2
VA enrollees
Number in millions
na
na
na
na
na
na
na
na
na
1.9
2.2
2.8
3.2
3.3
3.4
3.5
3.5
VA patients
0.9
0.9
1.0
1.0
1.0
1.1
1.1
1.1
1.3
1.4
1.6
1.9
2.2
2.3
2.4
2.4
2.4
na Data not available.
Note: Department of Veterans Affairs (VA) enrollees are veterans who have signed up to receive health care from the Veterans Health
Administration (VHA). VA patients are veterans who have received care each year through VHA. Starting with 1999 data, the methods used
to calculate VA patients differ from what was used in Older Americans 2004 and Older Americans Update 2006. Veterans who received care but
were not enrolled in VAare now included in patient counts. VHA Vital Status files from the Social Security Administration (SSA) are now used
to ascertain veteran deaths.
Reference population: These data refer to the total veteran population, VHA enrollment population, and VHA patient population.
Source: Department of Veterans Affairs, Veteran Population 2004 Version 1.0; Fiscal 2006 Year-end Office of the Assistant Deputy Under
Secretary for Health for Policy and Planning Enrollment file linked with August 2007 VHA Vital Status data (including data from VHA, VA,
Medicare, and SSA).
-------
INDICATOR 36
Nursing Home Utilization
Table 36a. Rate of nursing home residence among people age
65 and over, by sex and age group, selected years 1985-2004
Sex and age group
1985
1995
1997
1999
2004
Rate per thousand
Both sexes
65 and over
65-74
75-84
85 and over
Men
65 and over
65-74
75-84
85 and over
Women
65 and over
65-74
75-84
85 and over
White
65 and over
65-74
75-84
85 and over
Black
65 and over
65-74
75-84
85 and over
54.0
12.5
57.7
220.3
38.8
10.8
43.0
145.6
61.5
13.8
66.4
250.1
55.4
12.3
59.1
228.7
41.5
15.4
45.3
141.5
46.4
10.2
46.1
200.9
33.0
9.6
33.5
131.5
52.8
10.7
54.3
228.1
45.8
9.3
45.0
203.2
50.8
18.5
57.8
168.2
45.4
10.8
45.5
192.0
32.0
9.8
34.6
119.0
52.0
11.6
52.7
221.6
44.5
10.0
44.2
192.4
54.4
19.2
60.6
186.0
43.3
10.8
43.0
182.5
30.6
10.3
30.8
116.5
49.8
11.2
51.2
210.5
41.9
10.0
40.5
181.8
55.5
18.2
66.5
182.8
34.8
9.4
36.1
138.7
24.1
8.9
27.0
80.0
40.4
9.8
42.3
165.2
34.0
8.5
35.2
139.4
49.9
20.2
55.5
160.7
Note: Rates are calculated using estimates of the civilian population of the United States including institutionalized
people. Population data are from unpublished tabulations provided by the U.S. Census Bureau. The 2004 population
estimates are postcensal estimates as of July 1,2004, based on Census 2000. For more information about the 2004
population estimates, see the Technical Notes in Kozak, DeFrances, and Hall.44 Age adjusted to the year 2000 population
standard using the following three age groups: 65-74 years, 75-84 years, and 85 years and over. Residents are
people on the roster of the nursing home as of the night before the survey. Residents for whom beds are maintained
even though they may be away on overnight leave or in a hospital are included. People residing in personal care or
domiciliary care homes are excluded. Numbers have been revised and differ from previous editions of Older Americans.
See Appendix B for the definition of race and Hispanic origin in the National Nursing Home Survey.
Reference population: These data refer to the resident population.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Nursing Home Survey.
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INDICATOR 36
Nursing Home Utilization continued
Table 36b. Number of current nursing home residents age 65 and over, by
sex and age group, selected years 1985-2004
Sex and age group
Both sexes
65 and over
65-74
75-84
85 and over
Men
65 and over
65-74
75-84
85 and over
Women
65 and over
65-74
75-84
85 and over
White
65 and over
65-74
75-84
85 and over
Black
65 and over
65-74
75-84
85 and over
1985
1,318
212
509
597
334
81
141
113
984
132
368
485
1,227
188
474
566
82
22
31
29
1995
1,423
190
510
724
357
79
144
133
1,066
110
365
590
1,272
154
451
666
123
30
47
46
1997
Number in thousands
1,465
198
528
738
372
81
159
132
1,093
118
369
606
1,295
161
464
670
137
31
52
54
1999
1,470
195
518
757
378
84
150
144
1,092
111
368
613
1,280
157
441
682
146
30
59
57
2004
1,317
174
469
674
337
75
141
121
980
99
328
554
1,149
134
406
609
145
35
55
56
Note: Residents are people on the roster of the nursing home as of the night before the survey. Residents for whom
beds are maintained even though they may be away on overnight leave or in a hospital are included. People residing in
personal care or domiciliary care homes are excluded. Numbers have been revised and differ from previous editions of
Older Americans. See Appendix B for the definition of race and ethnicity in the National Nursing Home Survey.
Reference population: These data refer to the population residing in nursing homes.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Nursing Home
Survey.
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INDICATOR 36
Nursing Home Utilization continued
Table 36c. Percentage of nursing home residents age 65 and over, by amount of assistance
with activities of daily living (ADLs), 2004
Total nursing
home residents
Both Sexes
1,317,300
Men
336,900
Women
Number
980,400 1
White
,148,900
Black
145,400
Other
23,000
Number and Percent
Bathing
Total
No assistance
Some assistance
Total dependence
Dressing
Total
No assistance
Some assistance
Total dependence
Eating
Total
No assistance
Some assistance
Total dependence
Transferring
Total
No assistance
Some assistance
Total dependence
Toileting
Total
No assistance
Some assistance
Total dependence
1,298,700
6.3
55.2
38.5
1,300,300
15.6
58.4
26.1
1,302,400
64.5
20.5
15.0
1,293,900
26.8
51.2
22.0
1,297,800
20.3
48.0
31.7
330,000
8.2
56.4
35.4
330,500
17.2
59.8
23.1
331,600
69.3
17.7
13.0
329,000
31.4
50.0
18.6
330,500
22.9
48.4
28.7
968,700 1
5.7
54.8
39.5
969,800 1
15.0
57.9
27.1
970,800 1
62.9
21.4
15.7
964,900 1
25.2
51.6
23.1
967,300 1
19.5
47.8
32.7
,132,700
6.2
56.4
37.4
,134,200
15.7
59.0
25.4
,136,400
65.2
20.5
14.3
,128,600
26.8
52.3
20.9
,132,700
20.5
48.9
30.6
143,100
6.8
47.2
46.0
143,200
14.0
55.0
31.0
143,200
59.9
20.8
19.3
142,600
27.4
43.5
29.0
142,300
18.9
41.5
39.6
22,900
*
42.2
46.4
23,000
*20.2
50.0
*29.9
22,900
60.4
*15.1
*24.5
22,700
*24.0
45.7
*30.3
22,800
*20.9
41.8
37.3
"Estimate does not meet standard of reliability or precision because the sample size is less than 30. Estimates accompanied by an asterisk (*)
indicate that the sample size is between 30 and 59, or the sample size is greater than 59, but has a relative standard error of 30 percent or more.
Note: Residents are people on the roster of the nursing home as of the night before the survey. Residents for whom beds are maintained even
though they may be away on overnight leave or in a hospital are included. People residing in personal care or domiciliary care homes are
excluded. Excludes residents for whom activities did not occur and unknowns. ADL self-performance is ascertained for residents' performance
over all shifts during the last 7 days, not including setup of the activity. No assistance includes people who were coded as independent (no help
or oversight-or-help/oversight provided only 1 or 2 times during last 7 days) or receiving supervision (oversight, encouragement or cueing
provided 3 or more times during last 7 days).Some assistance includes people who were coded as limited assistance (resident highly involved
in activity; received physical help in guided maneuvering of limbs or other nonweight bearing assistances or more times-or-more help
provided only 1 or 2 times during last 7 days) or extensive assistance (while resident performed part of activity, over last 7 day period, help of
following type(s) provided 3 or more times: a) weight-bearing support and/or b) full staff performance during part (but not all) of last 7 days).
Total dependence includes people who were coded as full staff performance of activity during entire 7 days. See Appendix B for the definition
of race and Hispanic origin in the National Nursing Home Survey.
Reference population: These data refer to the population residing in nursing homes.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Nursing Home Survey.
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INDICATORS?
Residential Services
Table 37a. Percentage of Medicare enrollees age 65 and over residing in selected
residential settings, by age group, 2005
Residential setting
All settings
65 and over
33,394
65-74
Number in
16,116
75-84
thousands
1 2,703
85 and over
4,575
Percent
Total
Traditional community
Community housing
with services
Long-term care facilities
100.0
93.0
2.4
4.6
100.0
98.0
0.7
1.3
100.0
92.6
3.1
4.3
100.0
76.3
6.8
16.9
Note: Community housing with services applies to respondents who reported they lived in retirement communities or apartments,
senior citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care
facilities/homes, and similar situations, AND who reported they had access to one or more of the following services through their
place of residence: meal preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents
were asked about access to these services but not whether they actually used the services. A residence is considered a long-term care
facility if it is certified by Medicare or Medicaid; has 3 or more beds and is licensed as a nursing home or other long-term care facility
and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a caregiver.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 37b. Percentage of Medicare enrollees age 65 and over with
functional limitations, by residential setting, 2005
Functional status
Total
No functional limitations
IADL limitations only
1 -2 ADL limitations
3 or more ADL limitations
Traditional
community
100.0
63.6
10.6
20.1
5.7
Community
housing with
services
Percent
100.0
39.6
14.9
33.4
12.2
Long-term
care facility
100.0
5.8
11.9
18.0
64.4
Note: Community housing with services applies to respondents who reported they lived in retirement
communities or apartments, senior citizen housing, continuing care retirement facilities, assisted living
facilities, staged living communities, board and care facilities/homes, and similar situations, AND who
reported they had access to one or more of the following services through their place of residence: meal
preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents
were asked about access to these services but not whether they actually used the services. A residence
is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds and
is licensed as a nursing home or other long term care facility and provides at least one personal care
service; or provides 24-hour, 7-day-a-week supervision by a caregiver. Instrumental activities of daily
living (lADLs) limitations refer to difficulty performing (or inability to perform, for a health reason) one or
more of the following tasks: using the telephone, light housework, heavy housework, meal preparation,
shopping, or managing money. Only the questions on telephone use, shopping, and managing money
are asked of long-term care facility residents. Activities of daily living (ADLs) limitations refer to difficulty
performing (or inability to perform, for a health reason) the following tasks: bathing, dressing, eating,
getting in/out of chairs, walking, or toileting. Long-term care facility residents with no limitations
may include individuals with limitations in certain lADLs: doing light or heavy housework or meal
preparation. These questions were not asked of long-term care facility residents.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
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INDICATORS?
Residential Services continued
Table 37c. Availability of specific services among Medicare
enrollees age 65 and over residing in community housing
with services, 2005
People residing in community housing
with services who have access to...
Percent
Total 100.0
Prepared meals 85.6
Housekeeping,maid,or cleaning services 82.2
Laundry services 70.1
Help with medications 45.0
Note: Community housing with services applies to respondents who reported
they lived in retirement communities or apartments, senior citizen housing,
continuing care retirement facilities, assisted living facilities, staged living
communities, board and care facilities/homes, and similar situations, AND who
reported they had access to one or more services listed in the table through
their place of residence. Respondents were asked about access to these
services but not whether they actually used the services.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current
Beneficiary Survey.
Table 37d. Annual income distribution of Medicare enrollees
age 65 and over, by residential setting, 2005
Income
Total
$0-$ 10,000
10,001-20,000
20,001-30,000
30,001 or more
Traditional
community
100.0
15.0
26.9
21.5
36.7
Community
housing with
services
Percent
100.0
22.1
27.2
21.4
29.3
Long-term
care facility
100.0
40.1
31.9
13.9
14.1
Note: Community housing with services applies to respondents who reported they lived in retirement
communities or apartments, senior citizen housing, continuing care retirement facilities, assisted living
facilities, staged living communities, board and care facilities/homes, and similar situations, AND who
reported they had access to one or more of the following services through their place of residence: meal
preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents
were asked about access to these services but not whether they actually used the services. A residence
is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds and
is licensed as a nursing home or other long-term care facility and provides at least one personal care
service; or provides 24-hour, 7-day-a-week supervision by a caregiver. Income refers to annual income of
respondent and spouse. Table excludes data for respondents who reported only that their income was
greater or less than $25,000.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
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INDICATORS?
Residential Services continued
Table 37e. Characteristics of services available to Medicare
enrollees age 65 and over residing in community housing
with services, 2005
Selected characteristic
Percent
Services included in housing costs 100.0
All included 46.5
Some included/some separate 40.4
All separate 13.1
Can continue living there if they need substantial services 100.0
Yes 51.8
No 48.2
Note: Community housing with services applies to respondents who reported they
lived in retirement communities or apartments, senior citizen housing, continuing care
retirement facilities, assisted living facilities, staged living communities, board and care
facilities/homes, and similar situations, AND who reported they had access to one or more
of the following services through their place of residence: meal preparation, cleaning or
housekeeping services, laundry services, or help with medications. Respondents were
asked about access to these services but not whether they actually used the services.
Reference population: These data refer to Medicare enrollees.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
INDICATOR 38
Personal Assistance and Equipment
Table 38a. Distribution of noninstitutionalized Medicare enrollees age 65 and
over who have limitations in activities of daily living (ADLs), by type of assistance,
selected years 1992-2005
1992
1997
2001
2005
Personal assistance only
Equipment only
Personal assistance and equipment
None
9.2
28.3
20.9
41.6
5.6
34.2
21.4
38.8
6.3
36.3
22.0
35.3
6.6
36.3
21.9
35.2
Note: The Medicare Current Beneficiary Survey has replaced the National Long Term Care Survey as the data source for this
indicator. Consequently, the measurement of personal assistance and equipment has changed from previous editions of
Older Americans. ADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the
following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. Respondents who report difficulty with
an activity are subsequently asked about receiving help or supervision from another person with the activity and about using special
equipment or aids. In this table, personal assistance does not include supervision.
Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more ADLs.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 38b. Percentage of noninstitutionalized Medicare enrollees age 65 and over
who have limitations in instrumental activities of daily living (lADLs) and who receive
personal assistance, by age group, selected years 1992-2005
1992
1997
2001
2005
65-74
75-84
85 and over
58.9
63.2
69.2
61.8
63.2
71.1
60.9
66.5
73.7
62.7
67.4
74.0
Note: The Medicare Current Beneficiary Survey has replaced the National Long Term Care Survey as the data source for this
indicator. Consequently, the measurement of personal assistance has changed from previous editions of Older Americans. IADL
limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the
telephone, light housework, heavy housework, meal preparation, shopping, or managing money. Respondents who report difficulty
with an activity are subsequently asked about receiving help from another person with the activity. In this table, personal assistance
does not include supervision or special equipment.
Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more lADLs.
Source: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
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SPECIAL FEATURE
Literacy and Health Literacy
Literacy Table. Percentage of people age 65 and over in each literacy performance level,
by literacy component, 1992 and 2003
Prose
Document
Quantitative
1992
2003
1992
2003
1992
2003
Proficient
Intermediate
Basic
Below basic
3
27
37
33
4
34
38
23
2
29
31
38
3
38
33
27
5
18
29
49
5
24
37
34
Note: Literacy is measured using three different components: prose literacy is the ability to search, comprehend, and use
information from continuous texts (e.g., reading a newspaper); document literacy is the ability to search, comprehend, and use
information from noncontinuous texts (e.g., bus schedules); and quantitative literacy is the ability to identify and perform
computations using numbers embedded in printed materials (e.g., calculating numbers in tax forms).
Reference population: These data refer to people residing in households or prisons.
Source: U.S. Department of Education, National Center for Education Statistics, National Assessment of Adult Literacy.
Health Literacy Table. Percentage of people age 50 and over in each health literacy
performance level, by age group, 2003
65 and over
50-64
65-74
75 and over
Proficient
Intermediate
Basic
Below basic
3
38
30
29
12
53
21
13
5
44
29
23
1
29
31
39
Note: Health literacy is the ability to locate and understand health-related information and services and requires skills represented
in the three general components that make up literacy—prose, document, and quantitative literacy (see Literacy table above). Tasks
used to measure health literacy were organized around three domains of health and health care information and services—clinical,
prevention, and navigation of the health care system and mapped to the performance levels (proficient, intermediate, basic, and
below basic) based on their level of difficulty.
Reference population: These data refer to people residing in households or prisons.
Source: U.S. Department of Education, National Center for Education Statistics, National Assessment of Adult Literacy.
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Appendix B: Data Source Descriptions
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Air Quality System
The Air Quality System (AQS) contains ambient air pollution data collected by the U.S. Environmental
Protection Agency (EPA), State, local, and tribal air pollution control agencies. Data on criteria
pollutants consist of air quality measurements collected by sensitive equipment at thousands of
monitoring stations located across all 50 States, plus the District of Columbia, Puerto Rico, and the
U.S. Virgin Islands. Each monitor measures the concentration of a particular pollutant in the air.
Monitoring data indicate the average pollutant concentration during a specified time interval, usually
1 hour or 24 hours. AQS also contains meteorological data, descriptive information about each
monitoring station (including its geographic location and its operator), and data quality assurance
or quality control information. The system is administered by EPA, Office of Air Quality Planning
and Standards, Information Transfer and Program Integration Division, located in Research Triangle
Park, N.C.
For more information, contact:
David Mintz
U.S. Environmental Protection Agency
Phone: 919-541-5224
Website: www.epa.gov/air/data/aqsdb.html
American Housing Survey
The American Housing Survey (AHS) was mandated by Congress in 1968 to provide data for
evaluating progress toward "a decent home and a suitable living environment for every American
family." It is the primary source of detailed information on housing in the United States and is used to
generate a biennial report to Congress on the conditions of housing in the United States, among other
reports. The survey is conducted forthe Department of Housing and Urban Development by the U.S.
Census Bureau. The AHS encompasses a national survey and 21 metropolitan surveys and is designed
to collect data from the same housing units for each survey. The national survey, a representative
sample of approximately 60,000 housing units, is conducted biennially in odd numbered years; the
metropolitan surveys, representative samples of 3,500 housing units, are conducted in odd numbered
years on a 6-year cycle. The AHS collects data about the inventory and condition of housing in
the United States and the demographics of its inhabitants. The survey provides detailed data on the
types of housing in the United States and its characteristics and conditions; financial data on housing
costs, utilities, mortgages, equity loans, and market value; demographic data on family composition,
income, education, and race; and information on neighborhood quality and recent movers.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
Cheryl Levine
U.S. Department of Housing and Urban
Development
E-mail: Cheryl.A.Levine@hud.gov
Phone: 202-402-3928
Website: www.census.gov/hhes/www/ahs.html
American Time Use Survey
The American Time Use Survey (ATUS) is a nationally representative sample survey conducted for
the Bureau of Labor Statistics by the U.S. Census Bureau. The ATUS measures how people living in
the United States spend their time. Estimates show the kinds of activities people do and the time they
spent doing them by sex, age, educational attainment, labor force status, and other characteristics, as
well as by weekday and weekend day.
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ATUS respondents are interviewed one time about how they spent their time on the previous day,
where they were, and whom they were with. The survey is a continuous survey, with interviews
conducted nearly every day of the year and a sample that builds overtime. About 13,000 members of
the civilian noninstitutionalized population age 15 and over are interviewed each year.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
American Time Use Survey Staff
E-mail: atusinfo@bls.gov
Phone: 202-691-6339
Website: www.bls.gov/tus
Consumer Expenditure Survey
The Consumer Expenditure Survey (CE) is conducted for the Bureau of Labor Statistics by the U.S.
Census Bureau. The survey contains both a diary component and an interview component. Data are
integrated before publication. The data presented in this chartbook are derived from the integrated
data available on the CE website. The published data are weighted to reflect the U.S. population.
In the interview portion of the CE, respondents are interviewed once every 3 months for 5 consecutive
quarters. Respondents report information on consumer unit characteristics and expenditures during
each interview. Income data are collected during the second and fifth interviews only.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
E-mail: CEXINFO@bls.gov
Phone: 202-691-6900
Website: www.bls.gov/cex
Current Population Survey
The Current Population Survey (CPS) is a nationally representative sample survey of about 60,000
households conducted monthly for the Bureau of Labor Statistics (BLS) by the U.S. Census Bureau.
The CPS core survey is the primary source of information on the labor force characteristics of the
civilian noninstitutionalized population age 16 and over, including estimates of unemployment
released every month by BLS. Monthly CPS supplements provide additional demographic and social
data. The Annual Social and Economic Supplement (ASEC), or March CPS Supplement, is the
primary source of detailed information on income and poverty in the United States. The ASEC is
used to generate the annual Population Profile of the United States, reports on geographical mobility
and educational attainment, and detailed analyses of money income and poverty status.
Race and Hispanic origin: In 2003, for the first time CPS respondents were asked to identify
themselves as belonging to one or more of the six racial groups (white, black, American Indian and
Alaska Native, Asian, Native Hawaiian and other Pacific Islander, and Some Other Race); previously
they were to choose only one. People who responded to the question on race by indicating only one
race are referred to as the race alone or single-race population, and individuals who chose more than
one of the race categories are referred to as the Two-or-More-Races population.
The CPS includes a separate question on Hispanic origin. Starting in 2003, people of Spanish/
Hispanic/Latino origin could identify themselves as Mexican, Puerto Rican, Cuban, or Other Spanish/
Hispanic/Latino. People of Hispanic origin may be of any race.
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The 1994 redesign of the CPS had an impact on labor force participation rates for older men and
women. (See "Indicator 11: Participation in the Labor Force.") For more information on the effect of
the redesign, see "The CPS After the Redesign: Refocusing the Economic Lens."55
For more information regarding the CPS, its sampling structure and estimation methodology, see
"Explanatory Notes and Estimates of Error."56
For more information, contact:
Bureau of Labor Statistics
Department of Labor
E-mail: cpsinfo@bls.gov
Phone: 202-691-6378
Website: www.census.gov/cps/
Decennial Census
Every 10 years, beginning with the first census in 1790, the United States government conducts a
census, or count, of the entire population as mandated by the U.S. Constitution. The 1990 and 2000
censuses were taken April 1 of their respective years. As in several previous censuses, two forms
were used: a short form and a long form. The short form was sent to every household, and the long
form, containing the 100 percent questions plus the sample questions, was sent to approximately one
in every six households.
The Census 2000 short form questionnaire included six questions for each member of the household
(name, sex, age, relationship, Hispanic origin, and race) and whether the housing unit was owned or
rented. The long form asked more detailed information on subjects such as education, employment,
income, ancestry, homeowner costs, units in a structure, number of rooms, plumbing facilities, etc.
Race and Hispanic origin: In Census 2000, respondents were given the option of selecting one or
more race categories to indicate their racial identities. People who responded to the question on race
indicating only one of the six race categories (white, black, American Indian and Alaska Native,
Asian, Native Hawaiian and other Pacific Islander, and Some Other Race) are referred to as the
race alone or single-race population. Individuals who chose more than one of the race categories
are referred to as the Two-or-More-Races population. The six single-race categories, which made
up nearly 98 percent of all respondents, and the Two-or-More-Races category sum to the total
population. Because respondents were given the option of selecting one or more race categories to
indicate their racial identities, Census 2000 data on race are not directly comparable with data from
the 1990 or earlier censuses.
As in earlier censuses, Census 2000 included a separate question on Hispanic origin. In Census
2000, people of Spanish/Hispanic/Latino origin could identify themselves as Mexican, Puerto Rican,
Cuban, or Other Spanish/Hispanic/Latino. People of Hispanic origin may be of any race.
For more information, contact:
Age and Special Populations Branch
Phone: 301-763-2378
Website: www.census.gov/main/www/cen2000.html
Health and Retirement Study
The Health and Retirement Study (HRS) is a national panel study conducted by the University of
Michigan's Institute for Social Research under a cooperative agreement with the National Institute
on Aging. In 1992, the study had an initial sample of over 12,600 people from the 1931-1941 birth
cohort and their spouses. The HRS was joined in 1993 by a companion study, Asset and Health
Dynamics Among the Oldest Old (AHEAD), with a sample of 8,222 respondents (born before 1924
who were age 70 and over) and their spouses. In 1998, these two data collection efforts were combined
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into a single survey instrument and field period and were expanded through the addition of baseline
interviews with two new birth cohorts: Children of the Depression Age (CODA: 1924-1930) and
War Babies (WB: 1942-1947). Plans call for adding a new 6-year cohort of Americans entering
their 50s every 6 years. In 2004, baseline interviews were conducted with the Early Boomer birth
cohort (1948-1953). Telephone follow-ups are conducted every second year, with proxy interviews
after death. Beginning in 2006, one-half of this sample has an enhanced face-to-face interview that
includes the collection of physical measures and biomarker collection. The Aging, Demographics,
and Memory Study (ADAMS) is a supplement to HRS with the specific aim of conducting a
population-based study of dementia.
The combined studies, which are collectively called HRS, have become a steady state sample that
is representative of the entire U.S. population age 50 and over (excluding people who resided in a
nursing home or other institutionalized setting at the time of sampling). HRS will follow respondents
longitudinally until they die (including following people who move into a nursing home or other
institutionalized setting).
The HRS is intended to provide data for researchers, policy analysts, and program planners who
make major policy decisions that affect retirement, health insurance, saving, and economic well-
being. The study is designed to explain the antecedents and consequences of retirement; examine
the relationship between health, income, and wealth overtime; examine life cycle patterns of wealth
accumulation and consumption; monitor work disability; provide a rich source of interdisciplinary
data, including linkages with administrative data; monitor transitions in physical, functional, and
cognitive health in advanced old age; relate late-life changes in physical and cognitive health to
patterns of spending down assets and income flows; relate changes in health to economic resources
and intergenerational transfers; and examine how the mix and distribution of economic, family, and
program resources affect key outcomes, including retirement, spending down assets, health declines,
and institutionalization.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
Health and Retirement Study
E-mail: hrsquest@isr.umich.edu
Phone:734-936-0314
Website: hrsonline.isr.umich.edu
Medical Expenditure Panel Survey
The Medical Expenditure Panel Survey (MEPS) is an ongoing annual survey of the civilian
noninstitutionalized population that collects detailed information on health care use and expenditures
(including sources of payment), health insurance, income, health status, access, and quality of care.
MEPS, which began in 1996, is the third in a series of national probability surveys conducted by the
Agency for Healthcare Research and Quality on the financing and use of medical care in the United
States. MEPS predecessor surveys are the National Medical Care Expenditure Survey (NMCES)
conducted in 1977 and the National Medical Expenditure Survey (NMES) conducted in 1987. Each
of the three surveys (i.e., NMCES, NMES, and MEPS) used multiple rounds of in-person data
collection to elicit expenditures and sources of payments for each health care event experienced
by household members during the calendar year. To yield more complete information on health
care spending and payment sources, followback surveys of health providers were conducted for a
subsample of events in MEPS (and events in the MEPS predecessor surveys).
Since 1977, the structure of billing mechanism for medical services has grown more complex
as a result of increasing penetration of managed care and health maintenance organizations and
various cost-containment reimbursement mechanisms instituted by Medicare, Medicaid, and private
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insurers. As a result, there has been substantial discussion about what constitutes an appropriate
measure of health care expenditures.57 Health care expenditures presented in this report refer to
what is actually paid for health care services. More specifically, expenditures are defined as the
sum of direct payments for care received, including out-of-pocket payments for care received. This
definition of expenditures differs somewhat from what was used in the 1987 NMES, which used
charges (rather than payments) as the fundamental expenditure construct. To improve comparability
of estimates between the 1987 NMES and the 1996 and 2001 MEPS, the 1987 data presented in this
report were adjusted using the method described by Zuvekas and Cohen.54 Adjustments to the 1977
data were considered unnecessary because virtually all of the discounting for health care services
occurred after 1977 (essentially equating charges with payments in 1977).
A number of quality-related enhancements were made to the MEPS beginning in 2000, including the
fielding of an annual adult self-administered questionnaire (SAQ). This questionnaire contains items
on patient satisfaction and accountability measures from the Consumer Assessment of Healthcare
Providers and Systems (CAHPS®; previously known as the Consumer Assessment of Health Plans),
the SF-12 physical and mental health assessment tool, EQ-5D EuroQol 5 dimensions with visual
scale (2000-03), and several attitude items. Starting in 2004, the K-6 Kessler mental health distress
scale and the PH2 two-item depression scale were added to the SAQ.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
MEPS Project Director
E-mail: mepsprojectdirector@ahrq.hhs.gov
Phone: 301-427-1406
Website: www.meps.ahrq.gov/mepsweb
Medicare Current Beneficiary Survey
The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a
representative sample of the Medicare population designed to help the Centers for Medicare and
Medicaid Services (CMS) administer, monitor, and evaluate the Medicare program. The MCBS
collects information on health care use, cost, and sources of payment; health insurance coverage;
household composition; sociodemographic characteristics; health status and physical functioning;
income and assets; access to care; satisfaction with care; usual source of care; and how beneficiaries
get information about Medicare.
MCBS data enable CMS to determine sources of payment for all medical services used by Medicare
beneficiaries, including copayments, deductibles, and noncovered services; develop reliable and
current information on the use and cost of services not covered by Medicare (such as long-term
care); ascertain all types of health insurance coverage and relate coverage to sources of payment;
and monitor the financial effects of changes in the Medicare program. Additionally, the MCBS is the
only source of multidimensional person-based information about the characteristics of the Medicare
population and their access to and satisfaction with Medicare services and information about the
Medicare program. The MCBS sample consists of Medicare enrollees in the community and in
institutions.
The survey is conducted in three rounds per year, with each round being 4 months in length. MCBS
has a multistage, stratified, random sample design and a rotating panel survey design. Each panel
is followed for 12 interviews. In-person interviews are conducted using computer-assisted personal
interviewing. A sample of approximately 16,000 people are interviewed in each round. However,
because of the rotating panel design, only 12,000 people receive all three interviews in agiven calendar
year. Information collected in the survey is combined with information from CMS administrative
data files and made available through public-use data files.
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Race and Hispanic origin: The MCBS defines race as white, black, Asian, Native Hawaiian or Pacific
Islander, American Indian or Alaska Native, and other. People are allowed to choose more than one
category. There is a separate question on whether the person is of Hispanic or Latino origin. The
"other" category in Table 30c on page 118 consists of people who answered "no" to the Hispanic/
Latino question and who answered something other than "white" or "black" to the race question.
People who answer with more than one racial category are assigned to the "other" category.
For more information, contact:
MCBS Staff
E-mail: MCBS@cms.hhs.gov
Website: www.cms.hhs.gov/mcbs
The Research Data Assistance Center
E-mail: resdac@umn.edu
Phone: 888-973-7322
Website: www.resdac.umn.edu
National Assessment of Adult Literacy
The National Assessment of Adult Literacy, funded by the U.S. Department of Education and 12
States, was created in 1992 as a new measure of literacy. The aim of the survey was to profile the
English literacy of adults in the United States based on their performance across a wide array of tasks
that reflect the types of materials and demands they encounter in their daily lives.
To gather information on adults' literacy skills, trained staff interviewed a nationally representative
sample of nearly 13,600 individuals age 16 and over during the first 8 months of 1992. These
participants had been randomly selected to represent the adult population in the country as a whole.
Black and Hispanic households were oversampled to ensure reliable estimates of literacy proficiencies
and to permit analyses of the performance of these subpopulations. In addition, some 1,100 inmates
from 80 Federal and State prisons were interviewed to gather information on the proficiencies of the
prison population. In total, nearly 26,000 adults were surveyed.
Each survey participant was asked to spend approximately an hour responding to a series of
diverse literacy tasks, as well as questions about his or her demographic characteristics, educational
background, reading practices, and other areas related to literacy. Based on their responses to the
survey tasks, adults received proficiency scores along three scales that reflect varying degrees of
skill in prose, document, and quantitative literacy. The results of the 1992 survey were first published
in a report, Adult Literacy in America (NCES 93-275), in September 1993.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
Sheida White
National Center for Education Statistics
E-mail: Sheida.White@ed.gov
Website: nces.ed.gov/naal
National Health Interview Survey
The National Health Interview Survey (NHIS), conducted by the National Center for Health
Statistics, is a continuing nationwide sample survey in which data are collected during personal
household interviews. NHIS is the principal source of information on the health of the civilian,
noninstitutionalized, household population of the United States. Interviewers collect data on
illnesses, injuries, impairments, and chronic conditions; activity limitation caused by chronic
conditions; utilization of health services; and other health topics. Information is also obtained on
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personal, social, economic, and demographic characteristics, including race and ethnicity and health
insurance status. The survey is reviewed each year, core questionnaire items are revised every 10-15
years (with major revisions occurring in 1982 and 1997), and special topics are added or deleted
annually.
In 2006, a new sample design was implemented. This design, which is expected to be in use
through 2014, includes all 50 States and the District of Columbia, as the previous design did.
Oversampling of the black and Hispanic populations has been retained in 2006 to allow for more
precise estimation of health characteristics in these growing minority populations. The new sample
design also oversamples the Asian population. In addition, the sample adult selection process has
been revised so that when black, Hispanic, or Asian people age 65 and over are present, they have an
increased chance of being selected as the sample adult. The new design reduces the size of NHIS by
approximately 13 percent relative to the previous sample design. The interviewed sample for 2006
consisted of 29,204 households, which yielded 75,716 people in 29,868 families. More information
on the survey methodology and content of NHIS can be found at www.cdc.gov/nchs/nhis.htm.
Race and Hispanic origin: Starting with data year 1999, race-specific estimates in NHIS are tabulated
according to 1997 standards for Federal data on race and ethnicity and are not strictly comparable
with estimates for earlier years. The single race categories for data from 1999 and later (shown in
Tables 16a, 18, 2la, 22, 24b, and 26a on pages 100, 102, 106, 107, 109, and 111) conform to 1997
standards and are for people who reported only one racial group. Prior to data year 1999, data were
tabulated according to the 1977 standards and included people who reported one race or, if they
reported more than one race, identified one race as best representing their race. In Table 21a on page
106, estimates of non-Hispanic whites and non-Hispanic blacks in 1997 and 1998 are for people who
reported only a single race. In Table 26a on page 111, the white and black race groups include people
of Hispanic origin.
Additional background and health data for adults are available in Summary Health Statistics for the
U.S. Population: National Health Interview Survey.,58
For more information, contact:
NHIS staff
E-mail: nchsquery@cdc.gov
Phone: 866-441-6247
Website: www.cdc.gov/nchs/nhis.htm
National Health and Nutrition Examination Survey
The National Health and Nutrition Examination Survey (NHANES), conducted by the National
Center for Health Statistics, is a family of cross-sectional surveys designed to assess the health and
nutritional status of the noninstitutionalized civilian population through direct physical examinations
and interviews. Each survey's sample was selected using a complex, stratified, multistage, probability
sampling design. Interviewers obtain information on personal and demographic characteristics,
including age, household income, and race and ethnicity directly from sample persons (or their
proxies). In addition, dietary intake data, biochemical tests, physical measurements, and clinical
assessments are collected.
The NHANES program includes the following surveys conducted on a periodic basis through 1994:
the first, second, and third National Health Examination Surveys (NHES I, 1960-1962; NHES
II, 1963-1965; and NHES III, 1966-1970); and the first, second, and third National Health and
Nutritional Examination Surveys (NHANES I, 1971-1974; NHANES II, 1976-1980; and NHANES
III, 1988-1994). Beginning in 1999, NHANES changed to a continuous data collection format without
breaks in survey cycles. The NHANES program now visits 15 U.S. locations per year, surveying
and reporting for approximately 5,000 people annually. The procedures employed in continuous
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NHANES to select samples, conduct interviews, and perform physical exams have been preserved
from previous survey cycles. NHES I, NHANES I, and NHANES II collected information on people
6 months to 74 years of age. NHANES III and later surveys include people age 75 and over.
With the advent of the continuous survey design (NHANES III), NHANES moved from a 6-year
data release to a 2-year data release schedule. Estimates for 1999-2000, and later, are based on a
smaller sample size than estimates for earlier time periods and, therefore, are subject to greater
sampling error.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
NHANES
E-mail: nchsquery@cdc.gov
Phone: 866-441-6247
Website: www.cdc.gov/nchs/nhanes.htm
National Nursing Home Survey
The National Nursing Home Survey (NNHS), conducted by the National Center for Health
Statistics, provides information on characteristics of nursing homes and their residents and staff.
NNHS provides information on nursing homes from two perspectives: that of the provider of
services and that of the recipient. Data about the facilities include characteristics such as bed size,
ownership, affiliation, Medicare/Medicaid certification, specialty units, services offered, number and
characteristics of staff, expenses, and charges. Data about the current residents include demographic
characteristics, health status, level of assistance needed with activities of daily living, vision and
hearing impairment, continence, services received, sources of payment, and discharge disposition
(information on discharges was not collected in 1995 and 2004). The survey underwent a major
redesign in 2004. New content added to the survey included medications, medical, mental health,
and dental services offered or provided, end-of-life care and advance directives, education, specialty
credentials, and length of service of key staff, turnover and stability of nursing staff, use of contract/
agency staff, overtime shifts worked, wages and benefits, facility practices for immunization, dining,
and use of mechanical lifting devices.
The initial NNHS, conducted in 1973-1974, included the universe of nursing homes that provided
some level of nursing care and excluded homes providing only personal or domiciliary care. The 1977
and 1985 NNHS encompassed all types of nursing homes, including personal care and domiciliary
care homes. The 1995, 1997, 1999, and 2004 NNHS also included only nursing homes that provided
some level of nursing care and excluded homes providing only personal or domiciliary care, similar
to the 1973-1974 survey.
The Nursing Assistant Supplement to the 2004 NNHS was designed to determine the likelihood that
workers will continue in their present positions and the factors that affect those decisions, including
job satisfaction, environment, training, advancement opportunities, benefits, working conditions,
and personal or family demands. This first national survey of nursing assistants was conducted
as a separate telephone interview with a sample of workers who provide nursing home residents
assistance with activities of daily living (eating, transferring, toileting, dressing, and bathing).
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Race and Hispanic origin: Starting with data year 1999, the instruction for the race item on the Current
Resident Questionnaire was changed so that more than one race could be recorded. In previous years,
only one racial category could be checked. Estimates for racial groups presented in this table are for
residents for whom only one race was recorded. Estimates for residents where multiple races were
checked are unreliable because of small sample sizes and are not shown. Other race includes Asian,
Native Hawaiian or other Pacific Islander, American Indian or Alaska Native and multiple races.
For more information, contact:
E-mail: nchsquery@cdc.gov
Phone: 866-441-6247
Website: www.cdc.gov/nchs/nnhs.htm
National Vital Statistics System
Through the National Vital Statistics System, the National Center for Health Statistics collects and
publishes data on births, deaths, and prior to 1996, marriages and divorces occurring in the United
States based on U.S. standard certificates. The Division of Vital Statistics obtains information on
births and deaths from the registration offices of each of the 50 States, New York City, the District
of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, America Samoa, and Northern Mariana
Islands. Geographic coverage for births and deaths has been complete since 1933. Demographic
information on the death certificate is provided by the funeral director based on information
supplied by an informant. Medical certification of cause of death is provided by a physician, medical
examiner, or coroner. The mortality data file is a fundamental source of cause -of-death information
by demographic characteristics and for geographic areas such as States. The mortality file is one of
the few sources of comparable health-related data for smaller geographic areas in the United States
and over a long time period. Mortality data can be used not only to present the characteristics of those
dying in the United States but also to determine life expectancy and to compare mortality trends with
other countries. Data for the entire United States refer to events occurring within the United States;
data for geographic areas are by place of residence.
Race and Hispanic origin: Race and Hispanic origin are reported separately on the death certificate.
Therefore, data by race shown in Tables 14b, 15b, and 15c (on pages 93 and 96-99) include people
of Hispanic or non-Hispanic origin; data for Hispanic origin include people of any race.
For more information on the mortality data files, see "Deaths: Leading causes for 2004."59
For more information, contact:
Mortality Statistics Branch
E-mail: nchsquery@cdc.gov
Phone: 866-441-6247
Website: www.cdc.gov/nchs/deaths.htm
Panel Study of Income Dynamics
The Panel Study of Income Dynamics (PSID) is a nationally representative, longitudinal study
conducted by the University of Michigan's Institute for Social Research. It is a representative sample
of U.S. individuals (men, women, and children) and the family units in which they reside. Starting
with a national sample of 5,000 U.S. households in 1968, the PSID has reinterviewed individuals
from those households annually from 1968 to 1997 and biennially thereafter, whether or not they
are living in the same dwelling or with the same people. Adults have been followed as they have
grown older, and children have been observed as they advance through childhood and into adulthood,
forming family units of their own. Information about the original 1968 sample individuals and their
current coresidents (spouses, cohabitors, children, and anyone else living with them) is collected each
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year. In 1997 and 1999, in order to enhance the representativeness of the study, a refresher sample
of 511 post 1968 immigrant families was added to the PSID. With low attrition rates and successful
recontacts, the sample size grew to approximately 8,330 as of 2007. PSID data can be used for
cross-sectional, longitudinal, and intergenerational analyses and for studying both individuals and
families.
The central focus of the data has been economic and demographic, with substantial detail on income
sources and amounts, employment, family composition changes, and residential location. Based on
findings in the early years, the PSID expanded to its present focus on family structure and dynamics
as well as income, wealth, and expenditures. Wealth and health are other important contributors to
individual and family well-being that have been the focus of the PSID in recent years.
The PSID wealth modules measure net equity in homes and nonhousing assets divided into six
categories: other real estate and vehicles; farm or business ownership; stocks, mutual funds,
investment trusts, and stocks held in IRAs; checking and savings accounts, CDs, treasury bills,
savings bonds, and liquid assets in IRAs; bonds, trusts, life insurance, and other assets; and other
debts. The PSID measure of wealth excludes private pensions and rights to future Social Security
payments.
Race and Hispanic origin: The PSID asks respondents if they are white, black, American Indian,
Aleut, Eskimo, Asian, Pacific Islander, or another race. Respondents are allowed to choose more
than one category. They are coded according to the first category mentioned. Only respondents who
classified themselves as white or black are included in Table 10 on page 87.
For information, contact:
Frank Stafford
E-mail: fstaffor@isr.umich.edu orpsidhelp@isr.umich.edu
Phone:734-763-5166
Website: psidonline.isr.umich.edu
Population Projections
The population projections for the United States are interim projections that take into account the
results of Census 2000. These interim projections were created using the cohort-component method,
which uses assumptions about the components of population change. They are based on Census
2000 results, official postcensus estimates, as well as vital registration data from the National Center
for Health Statistics. The assumptions are based on those used in the projections released in 2000
that used a 1998 population estimate base. Some modifications were made to the assumptions so that
projected values were consistent with estimates from 2001 as well as Census 2000.
Fertility is assumed to increase slightly from current estimates. The projected total fertility rate in
2025 is 2.180, and it is projected to increase to 2.186 by 2050. Mortality is assumed to continue to
improve over time. By 2050, life expectancy at birth is assumed to increase to 81.2 for men and 86.7
for women. Net immigration is assumed to be 996,000 in 2025 and 1,097,000 in 2050.
Race and Hispanic origin: Interim projections based on Census 2000 were also done by race and
Hispanic origin. The basic assumptions by race used in the previous projections were adapted to
reflect the Census 2000 race definitions and results. Projections were developed for the following
groups: (1) non-Hispanic white alone, (2) Hispanic white alone, (3) black alone, (4) Asian alone,
and (5) all other groups. The fifth category includes the categories of American Indian and Alaska
Native, Native Hawaiian and Other Pacifc Islanders, and all people reporting more than one of the
major race categories defined by the Office of Management and Budget (OMB).
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For a more detailed discussion of the cohort-component method and the assumptions about the
components of population change, see "Methodology and Assumptions for the Population Projections
of the United States: 1999 to 2100."60 While this paper does not incorporate the updated assumptions
made for the interim projections, it provides a more extensive treatment of the earlier projections,
released in 2000, on which the interim series is based.
For more information, contact:
Population Projections Branch
Phone: 301-763-2428
Website: www.census.gov/population/www/projections/popproj.html
Survey of the Aged, 1963
The major purpose of the 1963 Survey of the Aged was to measure the economic and social situations
of a representative sample of all people age 62 and over in the United States in 1963 in order to serve
the detailed information needs of the Social Security Administration (SSA). The survey included a
wide range of questions on health insurance, medical care costs, income, assets and liabilities, labor
force participation and work experience, housing and food expenses, and living arrangements.
The sample consisted of a representative subsample (one-half) of the Current Population Survey
(CPS) sample and the full Quarterly Household Survey. Income was measured using answers to 17
questions about specific sources. Results from this survey have been combined with CPS results
from 1971 to the present in an income time series produced by SSA.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
Susan Grad
E-mail: susan.grad@ssa.gov
Phone: 202-358-6220
Website: www.socialsecurity.gov
Survey of Demographic and Economic Characteristics of the Aged,
1968
The 1968 Survey of Demographic and Economic Characteristics of the Aged was conducted by
the Social Security Administration (SSA) to provide continuing information on the socioeconomic
status of the older population for program evaluation. Major issues addressed by the study include
the adequacy of Old-Age, Survivors, Disability, and Health Insurance benefit levels, the impact of
certain Social Security provisions on the incomes of the older population, and the extent to which
other sources of income are received by older Americans.
Data for the 1968 Survey were obtained as a supplement to the Current Medicare Survey, which
yields current estimates of health care services used and charges incurred by people covered by the
hospital insurance and supplemental medical insurance programs. Supplemental questions covered
work experience, household relationships, income, and assets. Income was measured using answers
to 17 questions about specific sources. Results from this survey have been combined with results
from the Current Population Survey from 1971 to the present in an income time series produced by
SSA.
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Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
Susan Grad
E-mail: susan.grad@ssa.gov
Phone: 202-358-6220
Website: www.socialsecurity.gov
Survey of Veteran Enrollees' Health and Reliance Upon VA, 2005
The 2005 Survey of Veteran Enrollees' Health and Reliance Upon VA is the fifth in a series of
surveys of veteran enrollees for the Department of Veterans Affairs (VA) health care conducted by
the Veterans Health Administration (VHA), within the VA, under multiyear Office of Management
and Budget authority. Previous surveys of VHA-enrolled veterans were conducted in 1999, 2000,
2002, and 2003. All five VHA surveys of enrollees consisted of telephone interviews with stratified
random samples of enrolled veterans. In 2000, 2002, 2003, and 2005, the survey instrument was
modified to reflect VA management's need for specific data and information on enrolled veterans.
As with the other surveys in the series, the 2005 Survey of Veteran Enrollees' Health and Reliance
Upon VA sample was stratified by Veterans Integrated Service Network, enrollment priority, and
type of enrollee (new or past user). Telephone interviews averaged 15 minutes in length. In the
2005 survey, interviews were conducted from September 28, 2005, through December 12, 2005. Of
approximately 6.7 million eligible enrollees who had not declined enrollment as of December 31,
2004, some 42,000 completed interviews in the 2005 telephone survey.
VHA enrollee surveys provide a fundamental source of data and information on enrollees that cannot
be obtained in any other way except through surveys and yet are basic to many VHA activities.
The primary purpose of the VHA enrollee surveys is to provide critical inputs into VHA Health
Care Services Demand Model enrollment, patient, and expenditure projections, and the Secretary's
enrollment level decision processes; however, data from the enrollee surveys find their way into a
variety of strategic analysis areas related to budget, policy, or legislation.
VHA enrollee surveys provide particular value in terms of their ability to help identify not only who
VA serves but also to help supplement VA's knowledge of veteran enrollees' sociodemographic,
economic, and health characteristics, including household income, health insurance coverage status,
functional status (limitations in activities of daily living and instrumental activities of daily living),
perceived health status, race and ethnicity, employment status, smoking status, period of service and
combat status, other eligibilities and resources, their use of VA and non-VA health care services and
"reliance" upon VA, and their potential future use of VA health care services.
Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this
report.
For more information, contact:
Dee Ramsel
E-mail: dee.ramsel@va.gov
Phone: 414-384-2000, ext. 42353
Website: www 1 .va.gov/vhareorg
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Veteran Population Estimates and Projections (model name is
VetPop2004, December 2004)
VetPop2004 provides estimates and projections of the veteran population by age groups and other
demographic characteristics at the county and State levels. Veteran estimates and projections were
computed using a cohort-component approach, whereby Census 2000 baseline data were adjusted
forward in time on the basis of separations from the Armed Forces (new veterans) and expected
mortality.
Race and Hispanic origin: Data from this model are not shown by race and Hispanic origin in this
report.
For more information, contact:
Cathy Tomczak
E-mail: cathy.tomczak@va.gov
Phone: 202-461-5769
Website: www 1 .va.gov/vetdata
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Appendix C: Glossary
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Activities of daily living (ADLs): Activities of daily living (ADLs) are basic activities that
support survival, including eating, bathing, and toileting. See Instrumental activities of daily living
(I ADLs).
In the Medicare Current Beneficiary Survey, ADL disabilities are measured as difficulty performing
(or inability to perform because of a health reason) one or more of the following activities: eating,
getting in/out of chairs, walking, dressing, bathing, or toileting.
Asset income: Asset income includes money income reported in the Current Population Survey
from interest (on savings or bonds), dividends, income from estates or trusts, and net rental income.
Capital gains are not included.
Assistive device: Assistive device refers to any item, piece of equipment, or product system, whether
acquired commercially, modified, or customized, that is used to increase, maintain, or improve
functional capabilities of individuals with disabilities.
Body mass index: Body mass index (BMI) is a measure of body weight adjusted for height and
correlates with body fat. A tool for indicating weight status in adults, BMI is generally computed
using metric units and is defined as weight divided by height2 or kilograms/meters2. The categories
used in this report are consistent with those set by the World Health Organization. For adults 20
years of age and over, underweight is defined as having a BMI less than 18.5; healthy weight is
defined as having a BMI of at least 18.5 and less than 25; overweight is defined as having values
of BMI equal to 25 or greater; and obese is defined as having BMI values equal to 30 or greater.
To calculate your own body mass index, go to www.nhlbisupport.com/bmi. For more information
about BMI, see "Clinical guidelines on the identification, evaluation, and treatment of overweight
and obesity in adults."61
Cash balance pension plan: A hybrid pension plan that looks like a defined-contribution plan but
actually is a defined-benefit plan, a responsibility of the employer. In a cash balance plan, an employer
establishes an account for employees, contributes to the account, guarantees a return to the account,
and pays a lump sum benefit from the account at job termination.
Cause of death: For the purpose of national mortality statistics, every death is attributed to one
underlying condition, based on information reported on the death certificate and using the international
rules for selecting the underlying cause-of-death from the conditions stated on the death certificate.
The conditions that are not selected as underlying cause of death constitute the nonunderlying cause
of death, also known as multiple cause of death. Cause-of-death is coded according to the appropriate
revision of the International Classification of Diseases (ICD). Effective with deaths occurring in
1999, the United States began using the Tenth Revision of the ICD (ICD-10). Data from earlier
time periods were coded using the appropriate revision of the ICD for that time period. Changes in
classification of causes of death in successive revisions of the ICD may introduce discontinuities in
cause-of-death statistics overtime. These discontinuities are measured using comparability ratios.
These measures of discontinuity are essential to the interpretation of mortality trends. For further
discussion, see the "Mortality Technical Appendix" available at www.cdc.gov/nchs/deaths.htm62
See also comparability ratio; International Classification of Diseases; Appendix I, National Vital
Statistics System, Multiple Cause-of-Death File.63
Cause-of-death ranking: The cause-of-death ranking for adults is based on the List of 113 Selected
Causes of Death. The top-ranking causes determine the leading causes-of-death. Certain causes on
the tabulation lists are not ranked if, for example, the category title represents a group title (such
as "Major cardiovascular diseases" and "Symptoms, signs, and abnormal clinical and laboratory
findings, not elsewhere classified") or the category title begins with the words "Other" and "All
other." In addition, when a title that represents a subtotal (such as "Malignant neoplasm") is ranked,
its component parts are not ranked. Causes that are tied receive the same rank; the next cause is
assigned the rank it would have received had the lower-ranked causes not been tied (i.e., they skip
a rank).
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Cigarette smoking: Information about cigarette smoking in the National Health Interview Survey
is obtained for adults age 18 and over. Although there has been some variation in question wording,
smokers continue to be denned as people who have ever smoked 100 cigarettes and currently smoke.
Starting in 1993, current smokers are identified by asking the following two questions: "Have you
smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day,
some days, or not at all?" (revised definition). People who smoked 100 cigarettes and who now smoke
every day or some days are defined as current smokers. Before 1992, current smokers were identified
based on positive responses to the following two questions: "Have you smoked at least 100 cigarettes
in your entire life?" and "Do you smoke now?" (traditional definition). In 1992, cigarette smoking
data were collected for a half sample with one-half the respondents (a one-quarter sample) using
the traditional smoking questions and the other half of respondents (a one-quarter sample) using the
revised smoking question. An unpublished analysis of the 1992 traditional smoking measure revealed
that the crude percentage of current smokers age 18 and over remained the same as in 1991. The
statistics reported for 1992 combined data collected using the traditional and the revised questions.
The information obtained from the two smoking questions listed above is combined to create the
variables represented in Tables 26a and 26b on pages 111 and 112.
Current smoker: There are two categories of current smokers: people who smoke every day and
people who smoke only on some days.
Former smoker: This category includes people who have smoked at least 100 cigarettes in their
lifetimes but currently do not smoke at all.
Nonsmoker: This category includes people who have never smoked at least 100 cigarettes in their
lifetime.
Death rate: The death rate is calculated by dividing the number of deaths in a population in a year
by the midyear resident population. For census years, rates are based on unrounded census counts of
the resident population as of April 1. For the noncensus years of 1981-1989 and 1991, rates are based
on national estimates of the resident population as of July 1, rounded to the nearest thousand. Starting
in 1992, rates are based on unrounded national population estimates. Rates for the Hispanic and non-
Hispanic white populations in each year are based on unrounded State population estimates for States
in the Hispanic reporting area through 1996. Beginning in 1997, all States reported Hispanic origin.
Death rates are expressed as the number of deaths per 100,000 people. The rate may be restricted to
deaths in specific age, race, sex, or geographic groups or from specific causes of death (specific rate),
or it may be related to the entire population (crude rate).
Dental services: In the Medicare Current Beneficiary Survey (Indicators 30 and 34) and in the
Medical Expenditure Panel Survey (MEPS) and the data used from the MEPS predecessor surveys
used in this report (Indicator 33) this category covers expenses for any type of dental care provider,
including general dentists, dental hygienists, dental technicians, dental surgeons, orthodontists,
endodontists, and periodontists.
Disability: See Activities of daily living (ADLs) and Instrumental activities of daily living
(lADLs).
Earnings: Earnings are considered money income reported in the Current Population Survey from
wages or salaries and net income from self-employment (farm and nonfarm).
Emergency room services: In the Medical Expenditure Panel Survey (MEPS) and the data used from
the MEPS predecessor surveys used in this report (Indicator 33), this category includes expenses for
visits to medical providers seen in emergency rooms (except visits resulting in a hospital admission).
These expenses include payments for services covered under the basic facility charge and those for
separately billed physician services. In the Medicare Current Beneficiary Survey (Indicators 30 and
34) emergency room services are included as a hospital outpatient service unless they are incurred
immediately prior to a hospital stay, in which case they are included as a hospital inpatient service.
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Fee-for-service: This is the method of reimbursing health care providers on the basis of a fee for
each health service provided to the insured person.
Group quarters: For Census 2000, the U.S. Census Bureau classified all people not living in
households as living in group quarters. There are two types of group quarters: institutional (e.g.,
correctional facilities, nursing homes, and mental hospitals) and noninstitutional (e.g., college
dormitories, military barracks, group homes, missions, and shelters).
Head of household: In the Consumer Expenditure Survey head of household is defined as the first
person mentioned when the respondent is asked to name the person or people who own or rent the
home in which the consumer unit resides.
In the Panel Study of Income Dynamics (within each wave of data), each family unit has only
one current head of household (Head). Originally, if the family contained a husband-wife pair, the
husband was arbitrarily designated the Head to conform with U.S. Census Bureau definitions in
effect at the time the study began. The person designated as Head may change over time as a result
of other changes affecting the family. When a new Head must be chosen, the following rules apply:
The Head of the family unit must be at least 16 years old and the person with the most financial
responsibility for the family unit. If this person is female and she has a husband in the family unit,
then he is designated as Head. If she has a boyfriend with whom she has been living for at least 1
year, then he is Head. However, if the husband or boyfriend is incapacitated and unable to fulfill the
functions of Head, then the family unit will have a female Head.
Health care: Health care services provided by the Veterans Health Administration (Indicator 35)
includes preventive care, ambulatory diagnosis and treatment, inpatient diagnosis and treatment and
medications and supplies. This includes home and community based services (e.g., home health
care) and long-term care institutional services (for those eligible to receive these services).
Health care expenditures: In the Consumer Expenditure Survey (Indicator 12), health care
expenditures include out-of-pocket expenditures for health insurance, medical services, prescription
drugs, and medical supplies. In the Medicare Current Beneficiary Survey (Indicators 30 and 34),
health care expenditures include all expenditures for inpatient hospital, medical, nursing home,
outpatient (including emergency room visits), dental, prescription drugs, home health care, and
hospice services, including both out-of-pocket expenditures and expenditures covered by insurance.
Personal spending for health insurance premiums is excluded. In the Medical Expenditure Panel
Survey (MEPS) and the data used from the MEPS predecessor surveys used in this report (Indicator
33), health care expenditures refers to payments for health care services provided during the year.
(Data from the 1987 survey have been adjusted to permit comparability across years; see Zuvekas
and Cohen.54) Out-of-pocket health care expenditures are the sum of payments paid to health care
providers by the person or the person's family, for health care services provided during the year.
Health care services include inpatient hospital, hospital emergency room, and outpatient department
care; dental services; office-based medical provider services; prescription drugs; home health care;
and other medical equipment and services. Personal spending for health insurance premium(s) is
excluded.
Health Literacy: The degree to which individuals have the capacity to obtain, process, and
understand basic health information and services needed to make appropriate health decisions.49
Health maintenance organization (HMO): An HMO is a prepaid health plan delivering
comprehensive care to members through designated providers, having a fixed monthly payment for
health care services, and requiring members to be in a plan for a specified period of time (usually 1
year).
Hispanic origin: See specific data source descriptions in Appendix B.
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Home health care/services/visits: Home health care is care provided to individuals and families in
their places of residence for promoting, maintaining, or restoring health or for minimizing the effects
of disability and illness, including terminal illness. In the Medicare Current Beneficiary Survey and
Medicare claims data (Indicators 29, 30, and 34), home health care refers to skilled nursing care,
physical therapy, speech language pathology services, occupational therapy, and home health aide
services provided to homebound patients. In the Medical Expenditure Panel Survey (Indicator 33),
home health care services are classified into the "Other health care" category and are considered any
paid formal care provided by home health agencies and independent home health providers. Services
can include visits by professionals including nurses, doctors, social workers, and therapists, as well
as home health aids, homemaker services, companion services and home-based hospice care. Home
care provided free of charge (informal care by family members) is not included.
Hospice care/services: Hospice care is a program of palliative and supportive care services providing
physical, psychological, social, and spiritual care for dying persons, their families, and other loved
ones by a hospice program or agency. Hospice services are available in home and inpatient settings.
In the Medicare Current Beneficiary Survey (MCBS) (Indicators 30 and 34) hospice care includes
only those services provided as part of a Medicare benefit. In MCBS Indicator 30 (Medicare) hospice
services are included as part of the "Other" category. In MCBS Indicator 34 (Medicare) hospice
services are included as a separate category. In the Medical Expenditure Panel Survey (MEPS)
(Indicator 33) hospice care provided in the home (regardless of the source of payment) is included in
the "Other health care" category, while hospice care provided in an institutional setting (e.g., nursing
home) is excluded from the MEPS universe.
Hospital care: Hospital care in the Medical Expenditure Panel Survey (Indicator 33) includes
hospital inpatient care and care provided in hospital outpatient departments and emergency rooms.
Care can be provided by physicians or other health practitioners; payments for hospital care include
payments billed directly by the hospital and those billed separately by providers for services provided
in the hospital.
Hospital inpatient services: In the Medicare Current Beneficiary Survey (Indicators 30 and 34)
hospital inpatient services include room and board and all hospital diagnostic and laboratory expenses
associated with the basic facility charge, and emergency room expenses incurred immediately prior to
inpatient stays. Expenses for hospital stays with the same admission and discharge dates are included
if the Medicare bill classified the stay as an "inpatient" stay. Payments for separate billed physician
inpatient services are excluded. In the Medical Expenditure Panel Survey (Indicator 33) these
services include room and board and all hospital diagnostic and laboratory expenses associated with
the basic facility charge, payments for separately billed physician inpatient services, and emergency
room expenses incurred immediately prior to inpatient stays. Expenses for reported hospital stays
with the same admission and discharge dates are also included.
Hospital outpatient services: These services in the Medicare Current Beneficiary Survey (Indicators
30 and 34) include visits to both physicians and other medical providers seen in hospital outpatient
departments or emergency rooms (provided the emergency room visit does not result in an inpatient
hospital admission), as well as diagnostic laboratory and radiology services. Payments for these
services include those covered under the basic facility charge. Expenses for in-patient hospital stays
with the same admission and discharge dates and classified on the Medicare bill as "out-patient" are
also included. Separately billed physician services are excluded.
Hospital stays: Hospital stays in the Medicare claims data (Indicator 29) refers to admission to and
discharge from a short-stay acute care hospital.
Housing cost burden: In the American Housing Survey, housing cost burden is defined as expen-
ditures on housing and utilities in excess of 30 percent of reported income.
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Housing expenditures: In the Consumer Expenditure Survey's Interview Survey, housing expend-
itures include payments for mortgage interest; property taxes; maintenance, repairs, insurance, and
other expenses; rent; rent as pay (reduced or free rent for a unit as a form of pay); maintenance,
insurance, and other expenses for renters; and utilities.
Incidence: Incidence is the number of cases of disease having their onset during a prescribed period
of time. It is often expressed as a rate. For example, the incidence of measles per 1,000 children ages
5 to 15 during a specified year. Incidence is a measure of morbidity or other events that occur within
a specified period of time. See Prevalence.
Income: In the Current Population Survey, income includes money income (prior to payments for
personal income taxes, Social Security, union dues, Medicare deductions, etc.) from: (1) money
wages or salary; (2) net income from nonfarm self-employment; (3) net income from farm self-
employment; (4) Social Security or railroad retirement; (5) Supplemental Security Income; (6)
public assistance or welfare payments; (7) interest (on savings or bonds); (8) dividends, income
from estates or trusts, or net rental income; (9) veterans' payment or unemployment and worker's
compensation; (10) private pensions or government employee pensions; and (11) alimony or child
support, regular contributions from people not living in the household, and other periodic income.
Certain money receipts such as capital gains are not included.
In the Medicare Current Beneficiary Study, income is for the sample person, or the sample person and
spouse if the sample person was married at the time of the survey. All sources of income from jobs,
pensions, Social Security benefits, Railroad Retirement and other retirement income, Supplemental
Security Income, interest, dividends, and other income sources are included.
Income categories: Two income categories were used to examine out-of-pocket health care expend-
itures using the Medical Expenditure Panel Survey (MEPS) and MEPS predecessor survey data.
The categories were expressed in terms of poverty status (i.e., the ratio of the family's income to
the Federal poverty thresholds for the corresponding year), which controls for the size of the family
and the age of the head of the family. The income categories were (1) poor and near poor and (2)
other income. Poor and near poor income category includes people in families with income less
than 100 percent of the poverty line, including those whose losses exceeded their earnings, resulting
in negative income (i.e., the poor), as well as people in families with income from 100 percent
to less than 125 percent of the poverty line (i.e., the near poor). Other income category includes
people in families with income greater than or equal to 125 percent of the poverty line. See Income,
household.
Income, household: Household income from the Medical Expenditure Panel Survey (MEPS) and
the MEPS predecessor surveys used in this report was created by summing personal income from
each household member to create family income. Family income was then divided by the number of
people that lived in the household during the year to create per capita household income. Potential
income sources asked about in the survey interviews include annual earnings from wages, salaries,
withdrawals; Social Security and VA payments; Supplemental Security Income and cash welfare
payments from public assistance; Temporary Assistance for Needy Families, formerly known
as Aid to Families with Dependent Children; gains or losses from estates, trusts, partnerships, C
corporations, rent, and royalties; and a small amount of other income. See Income categories.
Income fifths: A population can be divided into groups with equal numbers of people based on the
size of their income to show how the population differs on a characteristic at various income levels.
Income fifths are five groups of equal size, ordered from lowest to highest income.
Inpatient hospital: See Hospital inpatient services.
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Institutions: For Census 2000, the U.S. Census Bureau denned institutions as correctional insti-
tutions; nursing homes; psychiatric hospitals; hospitals or wards for chronically ill or forthe treatment
of substance abuse; schools, hospitals or wards for the mentally retarded or physically handicapped;
and homes, schools, and other institutional settings providing care for children.64 See Population.
Institutionalized population: See Population.
Instrumental activities of daily living (lADLs): lADLs are indicators of functional well-being that
measure the ability to perform more complex tasks than the related activities of daily living (ADLs).
See Activities of daily living (ADLs).
In the Medicare Current Beneficiary Survey, lADLs include difficulty performing (or inability to
perform because of a health reason) one or more of the following activities: heavy housework, light
housework, preparing meals, using a telephone, managing money, or shopping.
Literacy: The ability to use printed and written information to function in society, to achieve one's
goals, and to develop one's knowledge and potential.
Long-term care facility: In the Medicare Current Beneficiary Survey (MCBS) (Indicators 20 and
37), a residence (or unit) is considered a long-term care facility if it is certified by Medicare or
Medicaid; has 3 or more beds and is licensed as a nursing home or other long-term care facility
and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by
a non-family, paid caregiver. In MCBS (Indicators 30 and 34), a long-term care facility excludes
"short-term institutions" (e.g., sub-acute care) stays. See Nursing home (Indicator 36), Short-term
institution (Indicators 30 and 34), and Skilled nursing home (Indicator 29).
Mammography: Mammography is an x-ray image of the breast used to detect irregularities in breast
tissue.
Mean: The mean is an average of n numbers computed by adding the numbers and dividing by n.
Median: The median is a measure of central tendency, the point on the scale that divides a group
into two parts.
Medicaid: This nationwide health insurance program is operated and administered by the States, with
Federal financial participation. Within certain broad, Federally determined guidelines, States decide
who is eligible; the amount, duration, and scope of services covered; rates of payment for providers;
and methods of administering the program. Medicaid pays for health care services, community-
based supports, and nursing home care, for certain low income people. Medicaid does not cover all
low-income people in every State. The program was authorized in 1965 by Title XIX of the Social
Security Act.
Medicare: This nationwide program provides health insurance to people age 65 and over, people
entitled to Social Security disability payments for 2 years or more, and people with end-stage renal
disease, regardless of income. The program was enacted July 30,1965, as Title XVIII, Health Insurance
forthe Aged of the Social Security Act, and became effective on July 1, 1966. Medicare covers acute
care services and postacute care settings such as rehabilitation and long-term care hospitals, and
generally does not cover nursing home care. Prescription drug coverage began in 2006.
Medicare Advantage: See Medicare Part C.
Medicare Part A: Medicare Part A (Hospital Insurance) covers inpatient care in hospitals, critical
access hospitals, skilled nursing facilities, and other postacute care settings such as rehabilitation and
long-term care hospitals. It also covers hospice and some home health care.
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Medicare Part B: Medicare Part B (Medical Insurance) covers doctor's services, outpatient hospital
care, and durable medical equipment. It also covers some other medical services that Medicare Part
A does not cover, such as physical and occupational therapy and some home health care. Medicare
Part B also pays for some supplies when they are medically necessary.
Medicare Part C: With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were
given the option to receive their Medicare benefits through private health insurance plans, instead of
through the Original Medicare plan (Parts A and B). These plans were known as "Medicare+Choice"
or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003, the types of plans allowed to contract with Medicare were expanded, and the Medicare
Choice program became known as "Medicare Advantage." In addition to offering comparable
coverage to Part A and Part B, Medicare Advantage plans may also offer Part D coverage.
Medicare Part D: Medicare Part D subsidizes the costs of prescription drugs for Medicare beneficiar-
ies. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003 (MMA) and went into effect on January 1, 2006. Beneficiaries can obtain the Medicare
drug benefit through two types of private plans: beneficiaries can join a Prescription Drug Plan
(POP) for drug coverage only or they can join a Medicare Advantage plan (MA) that covers both
medical services and prescription drugs (MA-PD). Alternatively, beneficiaries may receive drug
coverage through a former employer, in which case the former employer may qualify for a retiree
drug subsidy payment from Medicare.
Medigap: See Supplemental health insurance.
National population adjustment matrix: The national population adjustment matrix adjusts the
population to account for net underenumeration. Details on this matrix can be found on the U.S.
Census Bureau website: www.census.gov/population/www/censusdata/adjustment.html.
Nursing home: In the 2004 National Nursing Home Survey (Indicator 36), a nursing home is a
facility or unit licensed as a nursing home or a nursing facility by the State health department or
some other State agency and having three or more beds. Facilities providing care solely to the
mentally retarded and mentally ill are excluded. Facilities may be certified by Medicare or Medicaid,
or both. These facilities may be freestanding or nursing care units of hospitals, retirement centers,
or similar institutions where the unit maintained financial and resident records separate from those
of the larger institutions. For the definition of a nursing home as used in the 1985 National Nursing
Home Survey, see Appendix B under "National Nursing Home Survey." In the Medicare Current
Beneficiary Survey (Indicators 30 and 34), the category "nursing home" is not a mutually exclusive
category. See Skilled nursing facility (Indicator 29), Short-term institution (Indicators 30 and 34),
and Long-term care facility (Indicators 20, 30, 34, and 37).
Obesity: See Body mass index.
Office-based medical provider services: In the Medical Expenditure Panel Survey (Indicator 33)
this category includes expenses for visits to physicians and other health practitioners seen in office-
based settings or clinics. Other health practitioner includes audiologists, optometrists, chiropractors,
podiatrists, mental health professionals, therapists, nurses, and physician's assistants, as well as
providers of diagnostic laboratory and radiology services. Services provided in a hospital based
setting, including outpatient department services, are excluded.
Other health care: In the Medicare Current Beneficiary Survey (Indicator 34), this category includes
"short-term institution," "hospice," and "dental" services. In the Medical Expenditure Panel Survey
(MEPS) (Indicator 33) other health care includes "home health services" (formal care provided by
home health agencies and independent home health providers) and other medical equipment and
services. The latter includes expenses for eyeglasses, contact lenses, ambulance services, orthopedic
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items, hearing devices, prostheses, bathroom aids, medical equipment, disposable supplies,
alterations/modifications, and other miscellaneous items or services that were obtained, purchased,
or rented during the year.
Other income: Other income is total income minus retirement benefits, earnings, asset income,
and public assistance. It includes, but is not limited to, unemployment compensation, worker's
compensation, alimony, and child support.
Outpatient hospital: See Hospital outpatient services.
Out-of-pocket health care costs: These are health care costs that are not covered by insurance.
Overweight: See Body mass index.
Pensions: Pensions include money income reported in the Current Population Survey from railroad
retirement, company or union pensions (including profit sharing and 401(k) payments), IRAs,
Keoghs, regular payments from annuities and paid-up life insurance policies, Federal government
pensions, U.S. military pensions, and State or local government pensions.
Physician/Medical services: In the Medicare Current Beneficiary Survey (Indicator 34), this
category includes visits to a medical doctor, osteopathic doctor, and health practitioner as well as
diagnostic laboratory and radiology services. Health practitioners include audiologists, optometrists,
chiropractors, podiatrists, mental health professionals, therapists, nurses, paramedics, and physician's
assistants. Services provided in a hospital-based setting, including outpatient department services,
are included.
Physician/Outpatient hospital: In the Medicare Current Beneficiary Survey (Indicator 30), this
term refers to "physician/medical services" combined with "hospital outpatient services."
Physician visits and consultations: In Medicare claims data (Indicator 29) physician visits and
consultations include visits and consultations with primary care physicians, specialists, and
chiropractors in their offices, hospitals (inpatient and outpatient), emergency rooms, patient homes,
and nursing homes.
Population: Data on populations in the United States are often collected and published according
to several different definitions. Various statistical systems then use the appropriate population for
calculating rates.
Resident population: The resident population of the United States includes people resident in the 50
States and the District of Columbia. It excludes residents of the Commonwealth of Puerto Rico and
residents of the outlying areas under United States sovereignty or jurisdiction (principally American
Samoa, Guam, Virgin Islands of the United States, and the Commonwealth of the Northern Mariana
Islands). The definition of residence conforms to the criterion used in Census 2000, which defines
a resident of a specified area as a person "usually resident" in that area. The resident population
includes people resident in a nursing home and other types of institutional settings, but excludes
the U.S. Armed Forces overseas, as well as civilian U.S. citizens whose usual place of residence
is outside the United States. As defined in "Indicator 6: Older Veterans," the resident population
includes Puerto Rico.
Resident noninstitutionalizedpopulation: The resident noninstitutionalized population is the resident
population not residing in institutions. For Census 2000, institutions, as defined by the U.S. Census
Bureau, included correctional institutions; nursing homes; psychiatric hospitals; hospitals or wards
for chronically ill or for the treatment of substance abuse; homes and schools, hospitals or wards for
the mentally retarded or physically handicapped; and homes, schools, and other institutional settings
providing care for children. People living in noninstitutional group quarters are part of the resident
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noninstitutionalized population. For Census 2000, noninstitutional group quarters included group
homes (i.e., community-based homes that provide care and supportive services); residential facilities
"providing protective oversight ... to people with disabilities"; worker and college dormitories;
military and religious quarters; and emergency and transitional shelters with sleeping facilities.64
Civilian population: The civilian population is the U.S. resident population not in the active duty
Armed Forces.
Civilian noninstitutionalized population: The civilian noninstitutionalized population is the civilian
population not residing in institutions. For Census 2000, institutions, as denned by the U.S. Census
Bureau, included correctional institutions; nursing homes; psychiatric hospitals; hospitals or wards
for chronically ill or for the treatment of substance abuse; schools, hospitals or wards for the
mentally retarded or physically handicapped; and homes, schools, and other institutional settings
providing care for children. Civilians living in noninstitutional group quarters are part of the civilian
noninstitutionalized population. For Census 2000, noninstitutional group quarters included group
homes (i.e., "community based homes that provide care and supportive services"); residential facilities
"providing protective oversight ... to people with disabilities"; worker and college dormitories;
religious quarters; and emergency and transitional shelters with sleeping facilities.64
Institutionalized population: For Census 2000, the institutionalized population was the population
residing in correctional institutions; nursing homes; psychiatric hospitals; hospitals or wards for
chronically ill or for the treatment of substance abuse; schools, hospitals or wards for the mentally
retarded or physically handicapped; and homes, schools, and other institutional settings providing
care for children. People living in noninstitutional group quarters are part of the noninstitutionalized
population. For Census 2000, noninstitutional group quarters included group homes (i.e., "community
based homes that provide care and supportive services"); residential facilities "providing protective
oversight ... to people with disabilities"; worker and college dormitories; military and religious
quarters; and emergency and transitional shelters with sleeping facilities.64
Poverty: The official measure of poverty is computed each year by the U.S. Census Bureau and
is defined as being less than 100 percent of the poverty threshold (i.e., $9,669 for one person
age 65 and over in 2006).65 Poverty thresholds are the dollar amounts used to determine poverty
status. Each family (including single-person households) is assigned a poverty threshold based
upon the family's income, size of the family, and ages of the family members. All family members
have the same poverty status. Several of the indicators included in this report include a poverty
status measure. Poverty status (less than 100 percent of the poverty threshold) was computed for
"Indicator 7: Poverty," "Indicator 8: Income," "Indicator 17: Sensory Impairments and Oral Health,"
"Indicator 22: Mammography," and "Indicator 32: Sources of Health Insurance," and "Indicator 33:
Out-of-Pocket Health Care Expenditures" using the official U.S. Census Bureau definition for the
corresponding year.
In addition, the following above-poverty categories are used in this report.
Indicator 8: Income: The income categories are derived from the ratio of the family's income (or
an unrelated individual's income) to the poverty threshold. Being in poverty is measured as income
less than 100 percent of the poverty threshold. Low income is between 100 percent and 199 percent
of the poverty threshold (i.e., $9,669 and $19,337 for one person age 65 and over in 2006). Middle
income is between 200 percent and 399 percent of the poverty threshold (i.e., between $19,338 and
$38,675 for one person age 65 and over in 2006). High income is 400 percent or more of the poverty
threshold.
Indicator 22: Mammography and Indicator 32: Sources of Health Insurance: Below poverty
is defined as less than 100 percent of the poverty threshold. Above poverty is grouped into two
categories: (1) 100 percent to less than 200 percent of the poverty threshold and (2) 200 percent of
the poverty threshold or greater.
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Indicator 33: Out-of-Pocket Health Care Expenditures: Below poverty is defined as less than 100
percent of the poverty threshold. People are classified into the poor/near poor income category if the
person's household income is below 125 percent of the poverty level. People are classified into the
other income category if the person's household income is equal to or greater than 125 percent of
the poverty level.
Prescription drugs/medicines: In the Medicare Current Beneficiary Survey (Indicators 30, 31, 34)
and in the Medical Expenditure Panel Survey (Indicator 33) prescription drugs are all prescription
medications (including refills) except those provided by the doctor or practitioner as samples and
those provided in an inpatient setting.
Prevalence: Prevalence is the number of cases of a disease, infected people, or people with some
other attribute present during a particular interval of time. It is often expressed as a rate (e.g., the
prevalence of diabetes per 1,000 people during a year). See Incidence.
Private supplemental health insurance: See Supplemental health insurance.
Public assistance: Public assistance is money income reported in the Current Population Survey
from Supplemental Security Income (payments made to low-income people who are age 65 and
over, blind, or disabled) and public assistance or welfare payments, such as Temporary Assistance
for Needy Families and General Assistance.
Quintiles: See Income fifths.
Race: See specific data source descriptions in Appendix B.
Rate: A rate is a measure of some event, disease, or condition in relation to a unit of population,
along with some specification of time.
Reference population: The reference population is the base population from which a sample is
drawn at the time of initial sampling. See Population.
Respondent-assessed health status: In the National Health Interview Survey, respondent-assessed
health status is measured by asking the respondent, "Would you say [your/subject name's] health
is excellent, very good, good, fair, or poor?" The respondent answers for all household members
including himself or herself.
Short-term institution: This category in the Medicare Current Beneficiary Survey (Indicators 30
and 34) includes skilled nursing facility stays and other short-term (e.g., sub-acute care) facility stays
(e.g., a rehabilitation facility stay). Payments for these services include Medicare and other payment
sources. See Skilled nursing facility (Indicator 29), Nursing facility (Indicator 36), and Long-term
care facility (Indicators 20, 30, 34, and 37).
Skilled nursing facility stays: Skilled nursing facility stays in the Medicare claims data (Indicator
29) refers to admission to and discharge from a skilled nursing facility, regardless of the length of
stay. See Skilled nursing facility (Indicator 29).
Skilled nursing facility: A skilled nursing facility (SNF) as defined by Medicare (Indicator 29)
provides short-term skilled nursing care on an inpatient basis, following hospitalization. These
facilities provide the most intensive care available outside of inpatient acute hospital care. In the
Medicare Current Beneficiary Survey (Indicators 30 and 34) "skilled nursing facilities" are classified
as atype of "short-term institution." See Short-term institution (Indicators 30 and 34), Nursing home
(Indicator 36), and Long-term care facility (Indicators 20, 30, 34, and 37).
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Social Security benefits: Social Security benefits include money income reported in the Current
Population Survey from Social Security old-age, disability, and survivors' benefits.
Standard population: A population in which the age and sex composition is known precisely, as
a result of a census. A standard population is used as a comparison group in the procedure for
standardizing mortality rates.
Supplemental health insurance: Supplemental health insurance is designed to fill gaps in the
original Medicare plan coverage by paying some of the amounts that Medicare does not pay for
covered services and may pay for certain services not covered by Medicare. Private Medigap is
supplemental insurance individuals purchase themselves or through organizations such as AARP or
other professional organizations. Employer or union-sponsored supplemental insurance policies are
provided through a Medicare enrollee's former employer or union. For dual-eligible beneficiaries,
Medicaid acts as a supplemental insurer to Medicare. Some Medicare beneficiaries enroll in HMOs
and other managed care plans that provide many of the benefits of supplemental insurance, such as
low copayments and coverage of services that Medicare does not cover.
TRIG ARE: TRICARE is the Department of Defense's regionally managed health care program for
active duty and retired members of the uniformed services, their families, and survivors.
TRICARE for Life: TRICARE for Life is TRICARE's Medicare wraparound coverage (similar
to traditional Medigap coverage) for Medicare-eligible uniformed services beneficiaries and their
eligible family members and survivors.
Veteran: Veterans include those who served on active duty in the Army, Navy, Air Force, Marines,
Coast Guard, uniformed Public Health Service, or uniformed National Oceanic and Atmospheric
Administration; Reserve Force and National Guard called to Federal active duty; and those disabled
while on active duty training. Excluded are those dishonorably discharged and those whose only
active duty was for training or State National Guard service.
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The Historical Experience of Three Cohorts of Older Americans:
A Timeline of Selected Events 1923-2008
1923 Cohort Year
Historical Events
Legislative Events
5 years old
7 929 - Stock market crashes
1933 Cohort!
5 years old 15 years old
7934 - Federal Housing Administration created
by Congress; 7935- Social Security Act
passed; 1937- U.S. Housing Act passed,
establishing Public Housing
1943 Cohort!
7947 - Pearl Harbor; United States enters WWII
5 years old 15 years old 25 years old
7 945-Yalta Conference; Cold War begins
7946 - Baby Boom begins
7950 - United States enters Korean War
15 years old 25 years old 35 years old
25 years old 35 years old 45 years old
7955 - Nationwide polio vaccination program
begins
7964 - United States enters Vietnam War;
Baby Boom ends
7969 - First man on the moon
7956-Women age 62-64 eligible for reduced
Social Security benefits; 7957 - Social
Security Disability Insurance implement-
ed; 7 959-Section 202 of the Housing Act
established, providing assistance to older
adults with low income; 7967 - Men age
62-64 eligible for reduced Social Security
benefits; 7962- Self-Employed Individual
Retirement Act (Keogh Act) passed; 7964 -
Civil Rights Act passed; 7965-Medicare
and Medicaid established; Older Americans
Act passed; 7 967 - Age Discrimination in
Employment Act passed
35 years old 45 years old 55 years old
45 years old 55 years old 65 years old
7980-First AIDS case is reported to the
Centers for Disease Control and
Prevention
7989-Berlin Wall falls
7990-United States enters Persian Gulf War
7972 - Formula for Social Security cost-of-living
adjustment established; Social Security
Supplemental Security Income legislation
passed; 7974 - Employee Retirement
Income Security Act (ERISA) passed;
IRAs established; 7975-Age Discrimin-
ation Act passed; 7978-401 (k)s establish-
ed
7983 - Social Security eligibility age increased
for full benefits; 7984-Widows entitled
to pension benefits if spouse was vested
7986 - Mandatory retirement eliminated for
most workers; 7987 - Reverse mortgage
market created by the HUD Home Equity
Conversion Program
7990-Americans with Disabilities Act passed
55 years old 65 years old 75 years old
65 years old 75 years old 85 years old
2007 - September 11-Terrorists attack United
States
2003 - United States enters Iraq war
2008 - First Baby Boomers begin to turn 62
years old and become eligible for
Social Security retired worker benefits
7996 -Veterans'Health Care Eligibility Reform Act
passed, creating access to community based
long-term care for all enrollees; 7997- Bal-
anced Budget Act passed changing Medi-
care payment policies;2000 - Social Secur-
ity earnings test eliminated for full retire-
ment age;2003 - Medicare Modernization
Act passed
2005 - Deficit Reduction Act passed realigning
Medicaid incentives to provide noninsti-
tutionalized long-term care;2006-Medi-
care presciption drug benefit implemented;
Pension Protection Act passed
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